Provider Demographics
NPI:1033202056
Name:MORETTI, MICHEAL L (MD)
Entity Type:Individual
Prefix:
First Name:MICHEAL
Middle Name:L
Last Name:MORETTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 W 33RD ST
Mailing Address - Street 2:PBS 12TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-2603
Mailing Address - Country:US
Mailing Address - Phone:212-356-4474
Mailing Address - Fax:212-356-4608
Practice Address - Street 1:355 BARD AVE
Practice Address - Street 2:GYNECOLOGY/ PERINATOLOGY
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-1664
Practice Address - Country:US
Practice Address - Phone:718-818-3278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152103207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01252377Medicaid
NY01252377Medicaid
A98699Medicare UPIN