Provider Demographics
NPI:1861043507
Name:MORENO-ORTEGA, MARTA (PHD)
Entity Type:Individual
Prefix:MS
First Name:MARTA
Middle Name:
Last Name:MORENO-ORTEGA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 W 72ND ST APT 1C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-3476
Mailing Address - Country:US
Mailing Address - Phone:212-787-2222
Mailing Address - Fax:212-787-2224
Practice Address - Street 1:41 W 72ND ST APT 1C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-3476
Practice Address - Country:US
Practice Address - Phone:212-787-2222
Practice Address - Fax:212-787-2224
Is Sole Proprietor?:No
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist