Healthcare Provider Details

I. General information

NPI: 1992965784
Provider Name (Legal Business Name): ANA CORINA MORALES RN CNOR CRNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2008
Last Update Date: 12/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 PARK PL BLOOMFIELD
BLOOMFIELD NJ
07003-3526
US

IV. Provider business mailing address

57 PARK PL BLOOMFIELD
BLOOMFIELD NJ
07003-3526
US

V. Phone/Fax

Practice location:
  • Phone: 973-744-6079
  • Fax: 973-744-6079
Mailing address:
  • Phone: 973-744-6079
  • Fax: 973-744-6079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number26NO10460400
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1992965784
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: