Active NPI
Bruce Khalil Moore II, EMT
- Ambulance
- Hillside, NJ
National Provider Identifier
1124451257
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ambulance
- License
- 2012045
- Practice address
- 1101 Salem Ave
Hillside, NJ 07205-2834 - Phone
- (973) 558-6942
- NPI assigned
- Aug 13, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulance | 341600000X | 2012045 | NJ | Primary |
Addresses
Primary practice location
1101 Salem Ave
Hillside, NJ 07205-2834
Mailing address
1101 Salem Ave
Hillside, NJ 07120
Phone (973) 558-6942
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Emergency Medical Technician
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2012045 | NJ | MD | Ambulance |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Upscale Medical Transportation | Ambulance | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Ambulance
- Hillside, NJ
- NPI 1831430610
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1376352000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1376352000000",
"number": "1124451257",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1101 SALEM AVE",
"city": "HILLSIDE",
"state": "NJ",
"postal_code": "07120",
"telephone_number": "973-558-6942"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1101 SALEM AVE",
"city": "HILLSIDE",
"state": "NJ",
"postal_code": "072052834",
"telephone_number": "973-558-6942"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "BRUCE",
"middle_name": "KHALIL",
"name_suffix": "II",
"credential": "EMT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-08-13",
"last_updated": "2013-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "341600000X",
"taxonomy_group": "",
"desc": "Ambulance",
"state": "NJ",
"license": "2012045",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hillside, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.