Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 210894 | NY |
NPI | 1568415172 |
---|---|
Provider Name | Edwin Henry Moreano |
First Address | Jackson Heights, NY 11372-7901 |
Second Address | Jackson Heights, NY 11372-7901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G44847 | (02) |