Provider Demographics
NPI:1124192323
Name:MORIN, MORRIS ROBERT (DPM)
Entity Type:Individual
Prefix:
First Name:MORRIS
Middle Name:ROBERT
Last Name:MORIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-2233
Mailing Address - Country:US
Mailing Address - Phone:201-488-7577
Mailing Address - Fax:201-488-1807
Practice Address - Street 1:125 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-2233
Practice Address - Country:US
Practice Address - Phone:201-488-7577
Practice Address - Fax:201-488-1807
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD000943213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0844890001OtherDMERC
NJ1823507Medicaid
NJBS021OtherOXFORD
NJ1823507Medicaid
NJ0844890001OtherDMERC
NJT44607Medicare UPIN