Provider Demographics
NPI:1144689829
Name:MORALES, ENEIDA (RN)
Entity type:Individual
Prefix:
First Name:ENEIDA
Middle Name:
Last Name:MORALES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2114 HAVILAND AVE
Mailing Address - Street 2:APT 4D
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-5295
Mailing Address - Country:US
Mailing Address - Phone:646-807-7984
Mailing Address - Fax:
Practice Address - Street 1:900 INTERVALE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-4240
Practice Address - Country:US
Practice Address - Phone:718-732-7171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-23
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1144689829Medicaid