Provider Demographics
NPI:1548453913
Name:MORETTI, SONYA (CRNP)
Entity type:Individual
Prefix:
First Name:SONYA
Middle Name:
Last Name:MORETTI
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 SAINT JAMES PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-1264
Mailing Address - Country:US
Mailing Address - Phone:718-667-5541
Mailing Address - Fax:718-667-8834
Practice Address - Street 1:1050 CLOVE RD
Practice Address - Street 2:STATEN ISLAND PHYSICIAN PRACTICE
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-3627
Practice Address - Country:US
Practice Address - Phone:718-816-6440
Practice Address - Fax:718-816-3738
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY360401363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health