Provider Demographics
NPI:1033228770
Name:MORGAN, MICHELLE D (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:D
Last Name:MORGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-1458
Mailing Address - Country:US
Mailing Address - Phone:212-580-3866
Mailing Address - Fax:212-580-3867
Practice Address - Street 1:620 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-1458
Practice Address - Country:US
Practice Address - Phone:212-580-3866
Practice Address - Fax:212-580-3867
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211636174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH45499Medicare UPIN