Healthcare Provider Details

I. General information

NPI: 1528417763
Provider Name (Legal Business Name): JESSICA ANARUTH MORAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 CHARLES LINDBERGH BLVD
UNIONDALE NY
11553-3653
US

IV. Provider business mailing address

2302 WESTLEY RD
WESTBURY NY
11590-6018
US

V. Phone/Fax

Practice location:
  • Phone: 516-227-8646
  • Fax: 516-227-8663
Mailing address:
  • Phone: 516-865-2909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: