Healthcare Provider Details

I. General information

NPI: 1194479386
Provider Name (Legal Business Name): HAYLEEN E MORAN DDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2022
Last Update Date: 02/07/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 WARREN ST
NEW YORK NY
10007-1078
US

IV. Provider business mailing address

610 WARING AVE APT 2W
BRONX NY
10467-7714
US

V. Phone/Fax

Practice location:
  • Phone: 212-561-5303
  • Fax:
Mailing address:
  • Phone: 347-935-8954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number062299
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: