Individual
JOHN W MORENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPA-C
Contact information
Practice address
2915 SUNRISE HWY, ISLIP TERRACE, NY 11752-2716
(631) 665-8006
Mailing address
206 MARTHA AVE, EAST PATCHOGUE, NY 11772-4948
(631) 375-1577
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
012343
NY
Other
Enumeration date
02/07/2008
Last updated
02/07/2008
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