Provider Demographics
NPI:1922084466
Name:MORETA, HENRY G (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:G
Last Name:MORETA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:712 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-3620
Mailing Address - Country:US
Mailing Address - Phone:631-666-6393
Mailing Address - Fax:631-666-3994
Practice Address - Street 1:712 MAIN ST
Practice Address - Street 2:
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-3620
Practice Address - Country:US
Practice Address - Phone:631-666-6393
Practice Address - Fax:631-666-3994
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1403702084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01124390Medicaid
NYB78398Medicare UPIN
NY01124390Medicaid