Provider Demographics
NPI:1568035665
Name:MORINVIL, EMMANUEL (CCHT)
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:
Last Name:MORINVIL
Suffix:
Gender:M
Credentials:CCHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18619 122ND AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413-1074
Mailing Address - Country:US
Mailing Address - Phone:561-880-7258
Mailing Address - Fax:
Practice Address - Street 1:18619 122ND AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11413-1074
Practice Address - Country:US
Practice Address - Phone:561-880-7258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCCHT2472R0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2472R0900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherRenal DialysisGroup - Single Specialty