Provider Demographics
NPI:1619317401
Name:MORALES, STEWART LEE
Entity Type:Individual
Prefix:MR
First Name:STEWART
Middle Name:LEE
Last Name:MORALES
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 1:198 CALYER STREET
Mailing Address - Street 2:#1L
Mailing Address - City:BROOKKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222
Mailing Address - Country:US
Mailing Address - Phone:347-977-6961
Mailing Address - Fax:
Practice Address - Street 1:198 CALYER ST.
Practice Address - Street 2:#1L
Practice Address - City:BROOKKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222
Practice Address - Country:US
Practice Address - Phone:347-977-6961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY499866111174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator