Moises Emmanuel Azcona

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

25MT00303300 Issued in NJ

Practice address

111 W Union Ave
Bound Brook, NJ 08805-1396

Phone

(908) 986-8310

NPI assigned

Jan 21, 2025

Last updated

Jan 21, 2025By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

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

{
    "created_epoch": "1737417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737417600000",
    "number": "1831901578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1524 MAPLE AVE",
            "city": "HILLSIDE",
            "state": "NJ",
            "postal_code": "072051511",
            "telephone_number": "908-986-8310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 W UNION AVE",
            "city": "BOUND BROOK",
            "state": "NJ",
            "postal_code": "088051396",
            "telephone_number": "908-986-8310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AZCONA",
        "first_name": "MOISES",
        "middle_name": "EMMANUEL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-01-21",
        "last_updated": "2025-01-21",
        "certification_date": "2025-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NJ",
            "license": "25MT00303300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Athletic Trainer in Bound Brook, NJ
• Providers in Bound Brook, NJ by specialty
• Athletic Trainer in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2025; 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.