Healthcare Provider Details

I. General information

NPI: 1033186739
Provider Name (Legal Business Name): MICHELE MORANDI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 11/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 GALLOPING HILL RD SUITE 1
ROSELLE PARK NJ
07204-1700
US

IV. Provider business mailing address

PO BOX 416457
BOSTON MA
02241-6457
US

V. Phone/Fax

Practice location:
  • Phone: 908-241-0044
  • Fax: 908-241-0526
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMB062563
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: