MEDICARE: MRS. DAWN BLACK MSN

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
1	363LW0102X	Women's Health Nurse Practitioner	ARNP 2747772	FL
2	363LW0102X	Women's Health Nurse Practitioner	F421836-01	NY
3	363LW0102X	Women's Health Nurse Practitioner	26NJ15253600	NJ

General Provider Information

NPI Number	:	1538158753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DAWN BLACK MSN

Provider Business Mailing Address
First Line	:	228 PARK AVE S # 49404
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10003-1502
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	228 PARK AVE S # 49409
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10003-1502
Country	:	US
Telephone Number	:	646-760-6669
Fax Number	:	646-213-2042

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	02/02/2026

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