MEDICARE: MARIA LUISA DE LA MORENA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	223610	NY

General Provider Information

NPI Number	:	1316015761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA LUISA DE LA MORENA MD

Provider Business Mailing Address
First Line	:	1600 HARRISON AVE
Second Line	:	SUITE 205
City	:	MAMARONECK
State	:	NY
Zip	:	10543-3145
Country	:	US
Telephone Number	:	914-777-6600
Fax Number	:	914-777-6602

Provider Business Practice Location Address
First Line	:	1600 HARRISON AVE
Second Line	:	SUITE 205
City	:	MAMARONECK
State	:	NY
Zip	:	10543-3145
Country	:	US
Telephone Number	:	914-777-6600
Fax Number	:	914-777-6602

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2006
Last Update Date	:	07/08/2007

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