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NPI Code Detail

MEDICARE: DR. ELIZABETH MORENO DDS

MEDICARE: DR. ELIZABETH MORENO DDS
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
1122300000XDentist042663NY

General Provider Information

NPI Number : 1386639003
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ELIZABETH MORENO DDS
Provider Business Mailing Address
First Line : 1835 E HALLANDALE BEACH BLVD
Second Line : SUITE 565
City : HALLANDALE BEACH
State : FL
Zip : 33009-4619
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3556 RICHMOND AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10312-3253
Country : US
Telephone Number : 212-714-7003
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2005
Last Update Date : 01/22/2008

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