Healthcare Provider Details

I. General information

NPI: 1063608990
Provider Name (Legal Business Name): JJ MOREIRA MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 WILLIS AVE
MINEOLA NY
11501
US

IV. Provider business mailing address

319 WILLIS AVE FL 2
MINEOLA NY
11501-1510
US

V. Phone/Fax

Practice location:
  • Phone: 917-273-4092
  • Fax:
Mailing address:
  • Phone: 917-273-4092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number188071
License Number StateNY

VIII. Authorized Official

Name: JOSEPH JOHN MOREIRA
Title or Position: OWNER
Credential: MD
Phone: 917-273-4092