Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DS021089L | PA |
NPI | 1043219108 |
---|---|
Provider Name | Dr. E. Steven Moriconi |
First Address | Jenkintown, PA 19046-3206 |
Second Address | Jenkintown, PA 19046-3206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2005 |
Last Update Date | 31/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
17815 | AETNA (01) | PA |
427879 | IBC/HIGHMARK BLUE SHIELD (01) | PA |
427879F79 | MEDICARE RENDERING PROVID (01) | PA |
T71959 | (02) | PA |