Provider Demographics
NPI:1255547899
Name:MORAN, MARY MARGARET (RN)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:MARGARET
Last Name:MORAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ALDEN LN
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-2802
Mailing Address - Country:US
Mailing Address - Phone:631-698-5357
Mailing Address - Fax:
Practice Address - Street 1:6 ALDEN LN
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-2802
Practice Address - Country:US
Practice Address - Phone:631-698-5357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY362274-1163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00860182Medicaid