Healthcare Provider Details

I. General information

NPI: 1770295024
Provider Name (Legal Business Name): KIMBERLY ANN MORIANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 E 214TH ST
BRONX NY
10469-2412
US

IV. Provider business mailing address

2118 BOSTON POST RD
LARCHMONT NY
10538-3767
US

V. Phone/Fax

Practice location:
  • Phone: 718-823-3190
  • Fax:
Mailing address:
  • Phone: 914-246-1207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: