Provider Demographics
NPI:1548275837
Name:MOJARES, DENNIS EDGARDO C SR (MD)
Entity type:Individual
Prefix:DR
First Name:DENNIS EDGARDO
Middle Name:C
Last Name:MOJARES
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 MONMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764-1028
Mailing Address - Country:US
Mailing Address - Phone:732-571-0600
Mailing Address - Fax:
Practice Address - Street 1:175 MONMOUTH RD
Practice Address - Street 2:
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1028
Practice Address - Country:US
Practice Address - Phone:732-571-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA28091207P00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A478439OtherOXFORD
222356548OtherOPERATING ENGINEERS LOCAL
222356548OtherGEHA
222356548OtherCHN
222356548OtherCIGNA
222356548OtherHORIZON BLUE CROSS BLUE S
222356548OtherHEALTH NETWORK AMERICA
NJ3028607Medicaid
222356548OtherNEW JERSEY CARPENTERS FUN
222356548OtherCHN
460926RM9Medicare ID - Type Unspecified