Provider Demographics
NPI:1922571512
Name:MORGAN, GEORGETTE ALICIA
Entity Type:Individual
Prefix:DR
First Name:GEORGETTE
Middle Name:ALICIA
Last Name:MORGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 ROUTE 9W
Mailing Address - Street 2:
Mailing Address - City:PIERMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10968-1116
Mailing Address - Country:US
Mailing Address - Phone:845-680-1420
Mailing Address - Fax:845-789-8013
Practice Address - Street 1:225 BROADWAY STE 2710
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-3032
Practice Address - Country:US
Practice Address - Phone:646-875-8853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-07
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY943710151174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist