Provider Demographics
NPI:1144806498
Name:MORITA, SAE
Entity type:Individual
Prefix:
First Name:SAE
Middle Name:
Last Name:MORITA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:392 CENTRAL PARK W APT 11Y
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-5866
Mailing Address - Country:US
Mailing Address - Phone:347-866-8920
Mailing Address - Fax:
Practice Address - Street 1:392 CENTRAL PARK W APT 11Y
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-5866
Practice Address - Country:US
Practice Address - Phone:347-866-8920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health