Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | MD046772L | PA |
NPI | 1184678476 |
---|---|
Provider Name | Dr. Jay Morros |
First Address | Rydal, PA 19046-1207 |
Second Address | Philadelphia, PA 19146-8400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01129570725 | (05) | PA |
E95656 | (02) | |
MO719232 | HIGHMARK BS (01) | PA |