MEDICARE: DR. VANNA MORERO M.D.

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	207R00000X	Internal Medicine Physician	225071	NY

General Provider Information

NPI Number	:	1710947122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VANNA MORERO M.D.

Provider Business Mailing Address
First Line	:	6971 GRAND AVE
Second Line	:
City	:	MASPETH
State	:	NY
Zip	:	11378-1825
Country	:	US
Telephone Number	:	171-836-6158
Fax Number	:	718-963-6793

Provider Business Practice Location Address
First Line	:	6971 GRAND AVE
Second Line	:
City	:	MASPETH
State	:	NY
Zip	:	11378-1825
Country	:	US
Telephone Number	:	718-366-1583
Fax Number	:	718-963-6793

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

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	07/08/2007

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