Kanasha Moore

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

26NP07724100 Issued in NJ

Practice address

100 Broadway Ste a
Elmwood Park, NJ 07407-3088

Phone

(201) 749-2045

NPI assigned

Jul 19, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Walgreen Eastern Co Inc

  • Pharmacy
  • Elmwood Park, NJ
  • NPI 1710992797
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1689724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689724800000",
    "number": "1245910934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 BROADWAY STE A",
            "city": "ELMWOOD PARK",
            "state": "NJ",
            "postal_code": "074073088",
            "telephone_number": "201-796-0204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 BROADWAY STE A",
            "city": "ELMWOOD PARK",
            "state": "NJ",
            "postal_code": "074073088",
            "telephone_number": "201-749-2045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "KANASHA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-19",
        "last_updated": "2023-07-19",
        "certification_date": "2023-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NJ",
            "license": "26NP07724100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Moghaddasi, PHARMD
• Majd Mohsen, DMD
• Ashley Diana Mondati, MA, BCBA
• Hazel Sangil Mongelli, RPH
• Diana Marie Monteleon, RN, IBCLC
• Mariam Morcos, RN
• Karina Moreno
• Richard John Mucowski, EDD, PHD
• Marina Murkis, M.D.
• Muhammad Musaibuddin, PHARMD

• Licensed Practical Nurse in Elmwood Park, NJ
• Providers in Elmwood Park, NJ by specialty
• Licensed Practical Nurse in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.