Provider Demographics
NPI:1356890354
Name:MORA, CAROLINA (NP)
Entity type:Individual
Prefix:
First Name:CAROLINA
Middle Name:
Last Name:MORA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 ADRIAN AVE APT 1J
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-6561
Mailing Address - Country:US
Mailing Address - Phone:646-853-4934
Mailing Address - Fax:
Practice Address - Street 1:180 FORT WASHINGTON AVE.
Practice Address - Street 2:HARKNESS PAVILION 7TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-1003
Practice Address - Country:US
Practice Address - Phone:212-305-8555
Practice Address - Fax:212-305-3975
Is Sole Proprietor?:No
Enumeration Date:2016-10-02
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY340787363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05036457Medicaid