Provider Demographics
NPI:1083302715
Name:HENRIQUEZ MORALES, MARCOS JOSE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCOS
Middle Name:JOSE
Last Name:HENRIQUEZ MORALES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MARCOS
Other - Middle Name:JOSE
Other - Last Name:HENRIQUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:355 BARD AVENUE DEPARTMENT OF MEDICINE
Mailing Address - Street 2:VILLA BLDG 1ST FLOOR
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310
Mailing Address - Country:US
Mailing Address - Phone:718-818-2419
Mailing Address - Fax:
Practice Address - Street 1:355 BARD AVENUE DEPARTMENT OF MEDICINE
Practice Address - Street 2:VILLA BLDG. 1ST FLOOR
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310
Practice Address - Country:US
Practice Address - Phone:718-818-2419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program