Provider Demographics
NPI:1891042842
Name:MORALES, BERTA L (MSED)
Entity Type:Individual
Prefix:MRS
First Name:BERTA
Middle Name:L
Last Name:MORALES
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-2235
Mailing Address - Country:US
Mailing Address - Phone:201-244-6583
Mailing Address - Fax:
Practice Address - Street 1:143 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-2235
Practice Address - Country:US
Practice Address - Phone:201-244-6583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist