Provider Demographics
NPI:1972690014
Name:ENG - MORIARTY, MABEL (MD)
Entity Type:Individual
Prefix:
First Name:MABEL
Middle Name:
Last Name:ENG - MORIARTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13208-2523
Mailing Address - Country:US
Mailing Address - Phone:315-703-5270
Mailing Address - Fax:315-703-5271
Practice Address - Street 1:516 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13208-2523
Practice Address - Country:US
Practice Address - Phone:315-703-5270
Practice Address - Fax:315-703-5271
Is Sole Proprietor?:No
Enumeration Date:2006-10-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY253014208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03152458Medicaid