MEDICARE: CAROLINA MORA NP

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	363LF0000X	Family Nurse Practitioner	340787	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356890354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINA MORA NP

Provider Business Mailing Address
First Line	:	9 ADRIAN AVE APT 1J
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-6561
Country	:	US
Telephone Number	:	646-853-4934
Fax Number	:

Provider Business Practice Location Address
First Line	:	180 FORT WASHINGTON AVE.
Second Line	:	HARKNESS PAVILION 7TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10032-1003
Country	:	US
Telephone Number	:	212-305-8555
Fax Number	:	212-305-3975

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

Provider Enumeration Date	:	10/02/2016
Last Update Date	:	11/06/2018

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