Taewon Moon M.D. PA

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

TAEWON MOON M.D. PA

Practice address

464 Hudson Terrace
Suite 102
Englewood Cliffs, NJ 07632-2917

Phone

(201) 503-0066

Fax

(201) 503-0190

NPI assigned

Jan 28, 2019

Organization subpart

No

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

Authorized official

Name

Taewon Moon, MDNPI 1902843972

Title

President

Phone

(201) 503-0066

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Taewon Moon

  • Specialist
  • Englewood Cliffs, NJ
  • NPI 1902843972
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1548633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548633600000",
    "number": "1740744481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "464 HUDSON TERRACE",
            "address_2": "SUITE 102",
            "city": "ENGLEWOOD CLIFFS",
            "state": "NJ",
            "postal_code": "076322917",
            "telephone_number": "201-503-0066",
            "fax_number": "201-503-0190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "464 HUDSON TERRACE",
            "address_2": "SUITE 102",
            "city": "ENGLEWOOD CLIFFS",
            "state": "NJ",
            "postal_code": "076322917",
            "telephone_number": "201-503-0066",
            "fax_number": "201-503-0190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAEWON MOON M.D. PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-28",
        "last_updated": "2019-01-28",
        "status": "A",
        "authorized_official_last_name": "MOON",
        "authorized_official_first_name": "TAEWON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "201-503-0066",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Englewood Cliffs, NJ
• Providers in Englewood Cliffs, NJ by specialty
• Specialist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.