Provider Demographics
NPI:1457648735
Name:MORAN, NATHAN PERRY JR (LMT)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:PERRY
Last Name:MORAN
Suffix:JR
Gender:M
Credentials:LMT
Other - Prefix:
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Mailing Address - Street 1:55 BLOSSOM RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-2501
Mailing Address - Country:US
Mailing Address - Phone:716-228-4484
Mailing Address - Fax:
Practice Address - Street 1:5849 TRANSIT RD
Practice Address - Street 2:
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-1885
Practice Address - Country:US
Practice Address - Phone:716-688-9299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY024673225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY12273891OtherCAQH ID