Healthcare Provider Details

I. General information

NPI: 1861414096
Provider Name (Legal Business Name): PEDRO MORENO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 12/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 E 98TH ST 3RD FLOOR
NEW YORK NY
10029-6501
US

IV. Provider business mailing address

1 GUSTAVE L LEVY PL BOX 1030
NEW YORK NY
10029-6500
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-5586
  • Fax: 212-410-7196
Mailing address:
  • Phone: 212-241-3497
  • Fax: 212-534-2845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number001914
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number235294
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: