Provider Demographics
NPI:1649949942
Name:MORILLO, OLDANNY
Entity type:Individual
Prefix:
First Name:OLDANNY
Middle Name:
Last Name:MORILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 E 107TH ST APT 208
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-3911
Mailing Address - Country:US
Mailing Address - Phone:646-281-1040
Mailing Address - Fax:
Practice Address - Street 1:127 E 107TH ST APT 208
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-3911
Practice Address - Country:US
Practice Address - Phone:646-281-1040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-09
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVR01894CMedicaid