Provider Demographics
NPI:1538203914
Name:MOORE, DANIEL STEVEN (MSPT)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:STEVEN
Last Name:MOORE
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 DENOW RD
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-5246
Mailing Address - Country:US
Mailing Address - Phone:609-737-8130
Mailing Address - Fax:
Practice Address - Street 1:800 DENOW RD
Practice Address - Street 2:SUITE U
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-5246
Practice Address - Country:US
Practice Address - Phone:609-737-8130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-17
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00875000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ064269DEBMedicare PIN