Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 006371 | NY |
NPI | 1356576961 |
---|---|
Provider Name | Luis H. Mora |
First Address | Staten Island, NY 10306-4656 |
Second Address | Staten Island, NY 10306-4656 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2009 |
Last Update Date | 24/02/2014 |