Provider Demographics
NPI:1992823983
Name:MORGENSTERN, MARY JO (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY JO
Middle Name:
Last Name:MORGENSTERN
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 1:101 BARCLAY STREET 1 E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10286-0001
Mailing Address - Country:US
Mailing Address - Phone:212-815-4910
Mailing Address - Fax:212-815-3352
Practice Address - Street 1:101 BARCLAY STREET 1 E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10286-0001
Practice Address - Country:US
Practice Address - Phone:212-815-4910
Practice Address - Fax:212-815-3352
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1524832083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00971866Medicaid
NY32D00Medicare ID - Type Unspecified
NY00971866Medicaid