Healthcare Provider Details

I. General information

NPI: 1578844320
Provider Name (Legal Business Name): XIMENA MORALES MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2011
Last Update Date: 09/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 CARROLL ST
BROOKLYN NY
11231-2767
US

IV. Provider business mailing address

PO BOX 3254
JERSEY CITY NJ
07303-3254
US

V. Phone/Fax

Practice location:
  • Phone: 718-797-9797
  • Fax:
Mailing address:
  • Phone: 718-797-9797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number245656
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number245656
License Number StateNY

VIII. Authorized Official

Name: DR. XIMENA MORALES
Title or Position: OWNER
Credential: M.D
Phone: 718-797-9797