Healthcare Provider Details

I. General information

NPI: 1922093525
Provider Name (Legal Business Name): MARIA MORIARTY R.D.,C.D.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98120 QUEENS BLVD 1C
REGO PARK NY
11374-4357
US

IV. Provider business mailing address

6820 SELFRIDGE ST 1M
FOREST HILLS NY
11375-5746
US

V. Phone/Fax

Practice location:
  • Phone: 718-268-9598
  • Fax: 718-544-5754
Mailing address:
  • Phone: 718-268-9598
  • Fax: 718-544-5754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number000899-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: