Healthcare Provider Details

I. General information

NPI: 1316055999
Provider Name (Legal Business Name): JOSEPH JOHN MOREIRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 WILLIS AVE 2ND FLOOR
MINEOLA NY
11501-1510
US

IV. Provider business mailing address

50 THE INTERVALE
ROSLYN NY
11576-1909
US

V. Phone/Fax

Practice location:
  • Phone: 917-273-4092
  • Fax: 516-442-2251
Mailing address:
  • Phone: 917-273-4092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number053785
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberME124820
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number188071
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: