Healthcare Provider Details

I. General information

NPI: 1265550065
Provider Name (Legal Business Name): MARIA MORENO, MD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 E 88TH ST JAN J. SHIM, MD
NEW YORK NY
10128-0509
US

IV. Provider business mailing address

2 CATHARINE ST P.O. BOX 550
POUGHKEEPSIE NY
12601-3100
US

V. Phone/Fax

Practice location:
  • Phone: 212-535-5020
  • Fax: 845-790-2675
Mailing address:
  • Phone: 866-868-8418
  • Fax: 845-790-2675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateNY

VIII. Authorized Official

Name: MARIA MORENO
Title or Position: MD
Credential: MD
Phone: 866-868-8418