Provider Demographics
NPI:1396760757
Name:MORAN-ALMONTE, ROBERTO ANTONIO (MD)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:ANTONIO
Last Name:MORAN-ALMONTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 W 171ST ST APT W
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-2811
Mailing Address - Country:US
Mailing Address - Phone:212-927-3232
Mailing Address - Fax:212-927-4573
Practice Address - Street 1:707 W 171ST ST APT W
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-2811
Practice Address - Country:US
Practice Address - Phone:212-927-3232
Practice Address - Fax:212-927-4573
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY191897208000000X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01423147Medicaid
NY5330SH / 0026RUMedicare ID - Type Unspecified
NY01423147Medicaid