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NPI Code Detail

MEDICARE: AWILDA URENA RPAC

MEDICARE: AWILDA URENA RPAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant01078NY

General Provider Information

NPI Number : 1063468254
Entity Type Code : Individual
Provider Name (Legal Business Name) : AWILDA URENA RPAC
Provider Business Mailing Address
First Line : 55 WATER ST FL 2
Second Line :
City : NEW YORK
State : NY
Zip : 10041-0010
Country : US
Telephone Number : 646-680-2888
Fax Number : 516-542-5556
Provider Business Practice Location Address
First Line : 195 MONTAGUE ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11201-3628
Country : US
Telephone Number : 718-422-8000
Fax Number : 718-826-4413
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2006
Last Update Date : 09/30/2025

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