Provider Demographics
NPI:1437748910
Name:MORENO ROMAN, JOEL
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:MORENO ROMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 CAYUGA RD
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-1950
Mailing Address - Country:US
Mailing Address - Phone:716-842-0440
Mailing Address - Fax:716-819-3430
Practice Address - Street 1:301 CAYUGA RD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-1950
Practice Address - Country:US
Practice Address - Phone:716-842-0440
Practice Address - Fax:716-819-3430
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator