Healthcare Provider Details

I. General information

NPI: 1992823983
Provider Name (Legal Business Name): MARY JO MORGENSTERN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BARCLAY STREET 1 E
NEW YORK NY
10286-0001
US

IV. Provider business mailing address

101 BARCLAY STREET 1 E
NEW YORK NY
10286-0001
US

V. Phone/Fax

Practice location:
  • Phone: 212-815-4910
  • Fax: 212-815-3352
Mailing address:
  • Phone: 212-815-4910
  • Fax: 212-815-3352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number152483
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: