Provider Demographics
NPI:1245078062
Name:FABIAN-MORALES, WELLINGTON J (FNP)
Entity type:Individual
Prefix:
First Name:WELLINGTON
Middle Name:J
Last Name:FABIAN-MORALES
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1786 AMSTERDAM AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-3546
Mailing Address - Country:US
Mailing Address - Phone:212-548-6557
Mailing Address - Fax:212-918-8171
Practice Address - Street 1:1786 AMSTERDAM AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-3546
Practice Address - Country:US
Practice Address - Phone:212-548-6557
Practice Address - Fax:212-918-8171
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY354794363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily