Provider Demographics
NPI:1891189015
Name:MORRIS, MICHELLE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MORRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13421 SPRINGFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413-1448
Mailing Address - Country:US
Mailing Address - Phone:718-528-6377
Mailing Address - Fax:718-949-4580
Practice Address - Street 1:13421 SPRINGFIELD BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11413-1448
Practice Address - Country:US
Practice Address - Phone:718-528-6377
Practice Address - Fax:718-949-4580
Is Sole Proprietor?:No
Enumeration Date:2015-03-25
Last Update Date:2024-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD22638207R00000X
CT70455207R00000X
390200000X
NY295500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program