Provider Demographics
NPI:1669451415
Name:MORIMANDO, JAMES JOHN (RPA-C)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:JOHN
Last Name:MORIMANDO
Suffix:
Gender:M
Credentials:RPA-C
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Mailing Address - Street 1:2000 N VILLAGE AVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-1078
Mailing Address - Country:US
Mailing Address - Phone:516-678-2232
Mailing Address - Fax:516-678-8405
Practice Address - Street 1:2000 N VILLAGE AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-1078
Practice Address - Country:US
Practice Address - Phone:516-678-2232
Practice Address - Fax:516-678-8405
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002008-1363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1669451415Medicare PIN