Healthcare Provider Details

I. General information

NPI: 1861909335
Provider Name (Legal Business Name): MORNINGSIDE PEDIATRICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2018
Last Update Date: 01/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W 118TH ST APT 2
NEW YORK NY
10027-7216
US

IV. Provider business mailing address

401 W 118TH ST APT 2
NEW YORK NY
10027-7216
US

V. Phone/Fax

Practice location:
  • Phone: 212-666-4610
  • Fax: 212-666-3173
Mailing address:
  • Phone: 212-666-4610
  • Fax: 212-666-3173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number145492
License Number StateNY

VIII. Authorized Official

Name: DR. J.P PLENO MOISE
Title or Position: SOLE PARTNER
Credential: M.D.
Phone: 212-666-4610