Taewha Carolyn Moon, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

270A00465400 Issued in NJ

Practice address

225 Broad Ave Ste 206
Palisades Park, NJ 07650-1590

Phone

(201) 585-1337

Fax

(201) 585-2998

NPI assigned

Sep 23, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Coopercrwn NJ

  • Optometrist
  • Palisades Park, NJ
  • NPI 1801083050
  Medicare reassignment

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

{
    "created_epoch": "1158969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489017600000",
    "number": "1972603637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 BROAD AVE STE 206",
            "city": "PALISADES PARK",
            "state": "NJ",
            "postal_code": "076501590",
            "telephone_number": "201-585-1337",
            "fax_number": "201-585-2998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 BROAD AVE STE 206",
            "city": "PALISADES PARK",
            "state": "NJ",
            "postal_code": "076501590",
            "telephone_number": "201-585-1337",
            "fax_number": "201-585-2998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOON",
        "first_name": "TAEWHA",
        "middle_name": "CAROLYN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-23",
        "last_updated": "2017-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NJ",
            "license": "270A00465400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5084601",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• MJ Optometry Group, PC
• Moodlab Psychotherapy
• Hyesim Moon, NURSE PRACTITIONER
• Soojin Victoria Moon, RPH
• Sung Hee Moon
• Eun Young NA, ACUPUNCTURIST
• Namu Physical Therapy LLC
• Namu Wellness LLC
• Nec Acupuncture P.C
• Libby Nesvold, VMD

• Optometrist in Palisades Park, NJ
• Providers in Palisades Park, NJ by specialty
• Optometrist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.