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NPI Code Detail

MEDICARE: CHRISTIAN MORENO

MEDICARE: CHRISTIAN MORENO
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
1363A00000XPhysician AssistantNY

General Provider Information

NPI Number : 1689210361
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTIAN MORENO
Provider Business Mailing Address
First Line : 111 E 210TH ST
Second Line :
City : BRONX
State : NY
Zip : 10467-2401
Country : US
Telephone Number : 718-920-4321
Fax Number :
Provider Business Practice Location Address
First Line : 111 E 210TH ST
Second Line :
City : BRONX
State : NY
Zip : 10467-2401
Country : US
Telephone Number : 718-920-4321
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/18/2019
Last Update Date : 12/10/2025

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Directions to “ CHRISTIAN MORENO ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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