Provider Demographics
NPI:1356975783
Name:MORRA, CHRISTOPHER LAWRENCE (RN)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:LAWRENCE
Last Name:MORRA
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 1:42 FORDHAM AVE
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-5633
Mailing Address - Country:US
Mailing Address - Phone:631-260-4825
Mailing Address - Fax:
Practice Address - Street 1:42 FORDHAM AVE
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-5633
Practice Address - Country:US
Practice Address - Phone:631-260-4825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY431032163WC1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY83-4440115Medicaid