Healthcare Provider Details

I. General information

NPI: 1902858434
Provider Name (Legal Business Name): PLACIDO A MORANO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 7TH AVE
BROOKLYN NY
11215-3689
US

IV. Provider business mailing address

175 EUSTON RD
GARDEN CITY NY
11530-1201
US

V. Phone/Fax

Practice location:
  • Phone: 718-246-8600
  • Fax: 718-246-8601
Mailing address:
  • Phone: 718-743-9642
  • Fax: 718-246-8601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number175433
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: