Provider Demographics
NPI:1043893845
Name:MORON, ADRIANA JESSICA
Entity type:Individual
Prefix:
First Name:ADRIANA
Middle Name:JESSICA
Last Name:MORON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HOLLISTER RD UNIT 7
Mailing Address - Street 2:
Mailing Address - City:TETERBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07608-1139
Mailing Address - Country:US
Mailing Address - Phone:201-498-9140
Mailing Address - Fax:
Practice Address - Street 1:100 HOLLISTER RD UNIT 7
Practice Address - Street 2:
Practice Address - City:TETERBORO
Practice Address - State:NJ
Practice Address - Zip Code:07608-1139
Practice Address - Country:US
Practice Address - Phone:201-498-9140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator