Healthcare Provider Details

I. General information

NPI: 1952666901
Provider Name (Legal Business Name): ELEANOR MOREIRA MSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 07/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 SNEDEN PL W
SPRING VALLEY NY
10977-3918
US

IV. Provider business mailing address

111 SNEDEN PL W
SPRING VALLEY NY
10977-3918
US

V. Phone/Fax

Practice location:
  • Phone: 845-459-7127
  • Fax: 845-290-1179
Mailing address:
  • Phone: 845-459-7127
  • Fax: 845-290-1179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: