Healthcare Provider Details

I. General information

NPI: 1982886677
Provider Name (Legal Business Name): DEBORAH ELLEN MORAN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 E 51ST ST OFFICE B
NEW YORK NY
10022-8014
US

IV. Provider business mailing address

420 E 51ST ST OFFICE B
NEW YORK NY
10022-8014
US

V. Phone/Fax

Practice location:
  • Phone: 212-588-9599
  • Fax:
Mailing address:
  • Phone: 212-588-9599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number011904
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: