Provider Demographics
NPI:1992066815
Name:MORANO, LISA A
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:MORANO
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 1:6043 76TH ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-5246
Mailing Address - Country:US
Mailing Address - Phone:917-833-4472
Mailing Address - Fax:718-685-2268
Practice Address - Street 1:6043 76TH ST
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-5246
Practice Address - Country:US
Practice Address - Phone:917-833-4472
Practice Address - Fax:718-685-2268
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1164490174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist