Individual provider Active NPI

Micheal L Moretti, MD

  • Obstetrics & Gynecology Physician
  • Staten Island, NY
National Provider Identifier
1033202056
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
152103 Issued in NY
Practice address
355 Bard Ave
Gynecology/ Perinatology
Staten Island, NY 10310-1664
Phone
(718) 818-3278
NPI assigned
Oct 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 152103 NY Primary

Addresses

Primary practice location

355 Bard Ave
Gynecology/ Perinatology
Staten Island, NY 10310-1664

Mailing address

450 W 33Rd St
PBS 12TH Floor
New York, NY 10001-2603
Phone (212) 356-4474

Other identifiers 1

IdentifierTypeStateIssuer
01252377MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040515000051 NY Practitioner - Obstetrics/Gynecology 2668462250 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Other, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
TBHC Physician Services PCGroup PAC ID 9133265317, 111 clinicians

Practice addresses (Care Compare)

121 Dekalb Ave
Brooklyn, NY 11201-5425
Phone (718) 250-8000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
152103NYMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
TBHC Physician Services PC Obstetrics & Gynecology CurrentSince Sep 4, 2019 Accepting new patients
Amboy Medical Practice PC CurrentSince Oct 1, 2009 Accepting new patients
Amboy Medical Practice PC Obstetrics & Gynecology CurrentSince Sep 1, 2024 Accepting new patients
The Brooklyn Hospital Center Past Accepting new patients
Richmond University Medical Center Past Accepting new patients

Locations

121 DeKalb Ave
Brooklyn, NY 11201
Phone (718) 250-6604

4434 Amboy Rd
Staten Island, NY 10312
Phone (718) 818-1015

355 Bard Ave
Rm 208
Staten Island, NY 10310
Phone (718) 876-2979

275 Castleton Ave
Staten Island, NY 10301
Phone (718) 447-2829

355 Bard Ave
Staten Island, NY 10310
Phone (718) 818-1380

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H5989

Interoperability endpoints

  • Direct secure messaging: mmoretti17735@prd.direct.tbh.org

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1033202056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 W 33RD ST",
            "address_2": "PBS 12TH FLOOR",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100012603",
            "telephone_number": "212-356-4474",
            "fax_number": "212-356-4608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 BARD AVE",
            "address_2": "GYNECOLOGY/ PERINATOLOGY",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103101664",
            "telephone_number": "718-818-3278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORETTI",
        "first_name": "MICHEAL",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NY",
            "license": "152103",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01252377",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.