Provider Demographics
NPI:1225901994
Name:MORALES, OTTO (RN)
Entity type:Individual
Prefix:MR
First Name:OTTO
Middle Name:
Last Name:MORALES
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 W 212TH ST APT B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-1738
Mailing Address - Country:US
Mailing Address - Phone:917-440-0877
Mailing Address - Fax:
Practice Address - Street 1:517 W 212TH ST APT B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-1738
Practice Address - Country:US
Practice Address - Phone:917-440-0877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-27
Last Update Date:2025-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT234690163W00000X
NY938916163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse