Healthcare Provider Details

I. General information

NPI: 1679789085
Provider Name (Legal Business Name): VANESSA A MORENZI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ALBERT EINSTEIN MEDICAL CENTER PHILADELPHIA 5501 OLD YORK ROAD
PHILADELPHIA PA
19141
US

IV. Provider business mailing address

20 TREATY ELMS LANE
HADDONFIELD NJ
08033
US

V. Phone/Fax

Practice location:
  • Phone: 215-456-7104
  • Fax: 215-456-3482
Mailing address:
  • Phone: 856-816-2748
  • Fax: 856-428-7728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDI14269
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: