Provider Demographics
NPI:1730274762
Name:MOSSOCZY-GODYN, ANNA MARIE (MD)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:MOSSOCZY-GODYN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:MARIE
Other - Last Name:MOSSOCZY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:231 CROSSWICKS RD
Mailing Address - Street 2:STE 2
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505-2602
Mailing Address - Country:US
Mailing Address - Phone:609-298-7204
Mailing Address - Fax:609-298-0491
Practice Address - Street 1:231 CROSSWICKS RD
Practice Address - Street 2:STE 2
Practice Address - City:BORDENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08505-2602
Practice Address - Country:US
Practice Address - Phone:609-298-7204
Practice Address - Fax:609-298-0491
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA046193208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1745000Medicaid