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NPI Code Detail

MEDICARE: JOHN W MORENO RPA-C

MEDICARE: JOHN W MORENO RPA-C
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
1363AM0700XMedical Physician Assistant012343NY

General Provider Information

NPI Number : 1801074224
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN W MORENO RPA-C
Provider Business Mailing Address
First Line : 206 MARTHA AVE
Second Line :
City : EAST PATCHOGUE
State : NY
Zip : 11772-4948
Country : US
Telephone Number : 631-375-1577
Fax Number :
Provider Business Practice Location Address
First Line : 2915 SUNRISE HWY
Second Line :
City : ISLIP TERRACE
State : NY
Zip : 11752-2716
Country : US
Telephone Number : 631-665-8006
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2008
Last Update Date : 02/07/2008

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Directions to “ JOHN W MORENO RPA-C” Practice Location

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