Provider Demographics
NPI:1083177893
Name:MORALES, MADELINE L
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:L
Last Name:MORALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 10TH ST APT 3D
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-7310
Mailing Address - Country:US
Mailing Address - Phone:347-725-7870
Mailing Address - Fax:
Practice Address - Street 1:4110 10TH ST APT 3D
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-7310
Practice Address - Country:US
Practice Address - Phone:347-725-7870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator