Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0127X | Trauma Surgeon | 25MA08002700 | NJ |
Y | 2086S0127X | Trauma Surgeon | MD428666 | PA |
NPI | 1396799565 |
---|---|
Provider Name | Vincent Lavaughn Moss |
First Address | Edison, NJ 08820 |
Second Address | Edison, NJ 08820-3902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 24/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I34832 | (02) |