Individual provider Active NPI

Lisa B. Moreno, M.D.

  • Pediatric Allergy/Immunology Physician
  • New York, NY
National Provider Identifier
1508977208
Registry record updated Oct 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Allergy/Immunology PhysicianTaxonomy code 2080P0201X
License
223927 Issued in NY
Practice address
135 E 83Rd St
New York, NY 10028-2408
Phone
(212) 686-6321
NPI assigned
Aug 31, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2022

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy & Immunology Physician 207K00000X MD044781 DC
Allergy & Immunology Physician 207K00000X 223927 NY
Pediatrics Physician 208000000X 223927 NY
Pediatric Allergy/Immunology Physician 2080P0201X 223927 NY Primary

Addresses

Primary practice location

135 E 83Rd St
New York, NY 10028-2408

Mailing address

12 E 86TH St Apt 1530
New York, NY 10028-0516
Phone (718) 350-6680

Other practice location 1

110 W 97th St
New York, NY 10025-6450
Phone (212) 749-1820

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
I20050622000259 NY Practitioner - Allergy/ImmunologyPractitioner - Pediatric Medicine 0648215574 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD044781DCMDAllergy & Immunology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
William F Ryan Community Health Center Inc CurrentSince May 10, 2018 Accepting new patients
William F Ryan Community Health Center Inc CurrentSince May 10, 2018 Accepting new patients
Allergy & Asthma Associates of Murray Hill, P C Allergy & Immunology Past Accepting new patients
Ear, Nose & Throat Associates of New York,P.C. PastSince Oct 29, 2016 Accepting new patients
Midtown Sinus Imaging, PLLC PastSince Jan 1, 2011 Accepting new patients
ENT and Allergy Associates LLP Allergy & Immunology PastSince Jul 1, 2022 Accepting new patients

Locations

110 W 97th St
New York, NY 10025
Phone (212) 316-7906

Networks

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

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 7

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": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666137600000",
    "number": "1508977208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 E 86TH ST APT 1530",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100280516",
            "telephone_number": "718-350-6680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 E 83RD ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100282408",
            "telephone_number": "212-686-6321"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "110 W 97th St",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100256450",
            "country_code": "US",
            "telephone_number": "212-749-1820",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MORENO",
        "first_name": "LISA",
        "middle_name": "B.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2022-10-19",
        "certification_date": "2022-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "DC",
            "license": "MD044781",
            "primary": false
        },
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "NY",
            "license": "223927",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "223927",
            "primary": false
        },
        {
            "code": "2080P0201X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Allergy/Immunology",
            "state": "NY",
            "license": "223927",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.