Provider Demographics
NPI:1790348704
Name:MORANO, CALLIE LEA (MD)
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:LEA
Last Name:MORANO
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 1:130 OVERLOOK AVE APT 14F
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-2223
Mailing Address - Country:US
Mailing Address - Phone:228-282-3513
Mailing Address - Fax:
Practice Address - Street 1:130 OVERLOOK AVE APT 14F
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-2223
Practice Address - Country:US
Practice Address - Phone:228-282-3513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-16
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY318086207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine