=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457128175
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ERIN KATHERINE MORAN EKM PSYCHIATRY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2023
-----------------------------------------------------
Last Update Date | 12/04/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 450 W 42ND ST APT 45S
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10036-8215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-629-9772
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1280 LEXINGTON AVE FRNT 21381
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10028-2105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-703-6840
-----------------------------------------------------
Fax | 518-703-6876
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ERIN KATHERINE MORAN
-----------------------------------------------------
Credential | DNP, APRN, PMNP-BC
-----------------------------------------------------
Telephone | 518-703-6840
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------