Healthcare Provider Details

I. General information

NPI: 1114377199
Provider Name (Legal Business Name): JOSE ANDRES MORALES CORADO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ANDRES MORALES CORADO MD

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 BROADWAY
NEW YORK NY
10032-1559
US

IV. Provider business mailing address

3959 BROADWAY
NEW YORK NY
10032-1559
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-6731
  • Fax:
Mailing address:
  • Phone: 212-305-6731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number315615
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: