Provider Demographics
NPI:1275079956
Name:MORRA, MATTHEW (RN)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
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 1:47 ADIRONDACK DR
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-3201
Mailing Address - Country:US
Mailing Address - Phone:631-338-0579
Mailing Address - Fax:
Practice Address - Street 1:47 ADIRONDACK DR
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-3201
Practice Address - Country:US
Practice Address - Phone:631-338-0579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY719203163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse