Provider Demographics
NPI:1174027056
Name:MORALES, ELISHA S
Entity Type:Individual
Prefix:
First Name:ELISHA
Middle Name:S
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 1:1525 FIELDING ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-5903
Mailing Address - Country:US
Mailing Address - Phone:646-932-4322
Mailing Address - Fax:
Practice Address - Street 1:1525 FIELDING ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-5903
Practice Address - Country:US
Practice Address - Phone:646-932-4322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist