Provider Demographics
NPI:1316055999
Name:MOREIRA, JOSEPH JOHN (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JOHN
Last Name:MOREIRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 THE INTERVALE
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-1909
Mailing Address - Country:US
Mailing Address - Phone:917-273-4092
Mailing Address - Fax:
Practice Address - Street 1:319 WILLIS AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-1510
Practice Address - Country:US
Practice Address - Phone:917-273-4092
Practice Address - Fax:516-442-2251
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT053785204D00000X
FLME124820204D00000X
NY1880712084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
F85956Medicare UPIN