Provider Demographics
NPI:1053168336
Name:MORA MUNOZ, LAURA (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MORA MUNOZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 BERGEN STREET
Mailing Address - Street 2:SUITE 5200
Mailing Address - City:NEW JERSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-1709
Mailing Address - Country:US
Mailing Address - Phone:973-972-5209
Mailing Address - Fax:973-972-5059
Practice Address - Street 1:90 BERGEN STREET, SUITE 5200
Practice Address - Street 2:NEWARK, NJ 07101-1709
Practice Address - City:NEW JERSEY
Practice Address - State:NJ
Practice Address - Zip Code:07101-1709
Practice Address - Country:US
Practice Address - Phone:973-972-5209
Practice Address - Fax:973-972-5059
Is Sole Proprietor?:No
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program