Provider Demographics
NPI:1922093525
Name:MORIARTY, MARIA (RD,CDN)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:
Last Name:MORIARTY
Suffix:
Gender:F
Credentials:RD,CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6820 SELFRIDGE ST
Mailing Address - Street 2:1M
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5746
Mailing Address - Country:US
Mailing Address - Phone:718-268-9598
Mailing Address - Fax:718-544-5754
Practice Address - Street 1:98120 QUEENS BLVD
Practice Address - Street 2:1C
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4357
Practice Address - Country:US
Practice Address - Phone:718-268-9598
Practice Address - Fax:718-544-5754
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000899-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY163619OtherELDERPLAN
NYP466589OtherOXFORD
NY8000030OtherGHI
NY8000030OtherGHI