Provider Demographics
NPI:1710947122
Name:MORERO, VANNA (MD)
Entity Type:Individual
Prefix:DR
First Name:VANNA
Middle Name:
Last Name:MORERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6971 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-1825
Mailing Address - Country:US
Mailing Address - Phone:171-836-6158
Mailing Address - Fax:718-963-6793
Practice Address - Street 1:6971 GRAND AVE
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-1825
Practice Address - Country:US
Practice Address - Phone:718-366-1583
Practice Address - Fax:718-963-6793
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225071207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H79012Medicare UPIN
NY02359135Medicare ID - Type Unspecified
NY801V81Medicare ID - Type Unspecified