MEDICARE: ANTOINETTE MORAN P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	004432-1	NY

General Provider Information

NPI Number	:	1114921608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTOINETTE MORAN P.A.

Provider Business Mailing Address
First Line	:	3044 ROUTE 50
Second Line	:
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-2906
Country	:	US
Telephone Number	:	518-886-5800
Fax Number	:	518-886-5100

Provider Business Practice Location Address
First Line	:	3044 ROUTE 50
Second Line	:
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-2906
Country	:	US
Telephone Number	:	518-886-5800
Fax Number	:	518-886-5100

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	11/19/2010

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Directions to “ ANTOINETTE MORAN P.A.” Practice Location

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