MEDICARE: RACHEL MORADIAN

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	363A00000X	Physician Assistant	027611	NY

General Provider Information

NPI Number	:	1972243244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL MORADIAN

Provider Business Mailing Address
First Line	:	47 RUXTON RD
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11023-1528
Country	:	US
Telephone Number	:	718-810-8459
Fax Number	:

Provider Business Practice Location Address
First Line	:	47 RUXTON RD
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11023-1528
Country	:	US
Telephone Number	:	718-810-8459
Fax Number	:

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

Provider Enumeration Date	:	04/01/2022
Last Update Date	:	04/01/2022

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