Provider Demographics
NPI:1942664925
Name:MORETA, LATISHA ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:LATISHA
Middle Name:ELIZABETH
Last Name:MORETA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LATISHA
Other - Middle Name:ELIZABETH
Other - Last Name:RICKETTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:225 E 95TH ST APT 19J
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-4006
Mailing Address - Country:US
Mailing Address - Phone:516-509-9673
Mailing Address - Fax:
Practice Address - Street 1:315 W 57TH ST STE 208
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3149
Practice Address - Country:US
Practice Address - Phone:203-557-9696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-06
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1942664925207SG0201X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)