| Doctor Name: | MR. MOSES MYERS |
| NPI Number: | 1023196367 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MS, LCADC,SAP |
| License Number: | 37LC00083500 |
| Business Practice Address: | 2130 Millburn Ave Suite D1 Maplewood, NJ - 070403725 |
| Business Phone Number: | 9088755123 |
| Business Fax Number: | 9737638243 |
| Mailing Address: | 612 Thompson Ave, ROSELLE |
| State: | NJ |
| Postal Code: | 072032209 |
| Phone Number: | 9088755123 |
| Fax Number: | 9737638243 |
| NPI Enumeration Date: | 11/02/2006 |
| NPI Last Update Date: | 04/23/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 37LC00083500 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |