Provider Demographics
NPI:1184065500
Name:MORAN, NIA (NIA MORAN,SLP, IBCLC)
Entity type:Individual
Prefix:
First Name:NIA
Middle Name:
Last Name:MORAN
Suffix:
Gender:F
Credentials:NIA MORAN,SLP, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4356 SMART ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-2153
Mailing Address - Country:US
Mailing Address - Phone:718-664-0223
Mailing Address - Fax:
Practice Address - Street 1:4356 SMART ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2153
Practice Address - Country:US
Practice Address - Phone:718-664-0223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-14
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
NY025628235Z00000X
NYL-314594174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No174400000XOther Service ProvidersSpecialist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY025628OtherNYS SLP LICENSE
NY04603054Medicaid
NYL-314594OtherIBLCE