Active NPI
Marc Anthony Moran
- Behavior Technician
- Melrose Park, IL
National Provider Identifier
1154086916
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 1414 Main St
Melrose Park, IL 60160-3902 - Phone
- (708) 786-8530
- NPI assigned
- Nov 5, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | IL | Primary |
Addresses
Primary practice location
1414 Main St
Melrose Park, IL 60160-3902
Mailing address
1414 Main St
Melrose Park, IL 60160-3902
Phone (708) 786-8530
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477622298 | Other | IL | EMPLOYER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1636070400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1636070400000",
"number": "1154086916",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1414 MAIN ST",
"city": "MELROSE PARK",
"state": "IL",
"postal_code": "601603902",
"telephone_number": "708-786-8530"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1414 MAIN ST",
"city": "MELROSE PARK",
"state": "IL",
"postal_code": "601603902",
"telephone_number": "708-786-8530"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORAN",
"first_name": "MARC",
"middle_name": "ANTHONY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-11-05",
"last_updated": "2021-11-05",
"certification_date": "2021-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EMPLOYER",
"identifier": "1477622298",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Melrose Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.