MEDICARE: SONIA LOPEZ-MORIARTY NP-C

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	363LA2200X	Adult Health Nurse Practitioner	F303871-1	NY

General Provider Information

NPI Number	:	1831160175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONIA LOPEZ-MORIARTY NP-C

Provider Business Mailing Address
First Line	:	420 W 42ND ST
Second Line	:	APT 37B
City	:	NEW YORK
State	:	NY
Zip	:	10036-6848
Country	:	US
Telephone Number	:	212-706-7964
Fax Number	:

Provider Business Practice Location Address
First Line	:	57 W 57TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10019-2802
Country	:	US
Telephone Number	:	212-755-0200
Fax Number	:

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

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	07/08/2007

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