Healthcare Provider Details

I. General information

NPI: 1649724626
Provider Name (Legal Business Name): KARINA ISABEL MORENO MSN, RN, ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2016
Last Update Date: 08/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 1ST AVE
NEW YORK NY
10016-6402
US

IV. Provider business mailing address

545 1ST AVE GREENBERG HALL SUITE C-124
NEW YORK NY
10016-6401
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-7311
  • Fax:
Mailing address:
  • Phone: 212-263-8005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number685496-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberF431005-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: