Healthcare Provider Details

I. General information

NPI: 1003434457
Provider Name (Legal Business Name): NAURI ESTEFANI ABREU ROA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 06/10/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR ST
CHICAGO IL
60612-7232
US

IV. Provider business mailing address

BRONXLEBANON HEALTH SYSTEM 1650 GRAND CONCOURSE
BRONX NY
10457
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-4150
  • Fax:
Mailing address:
  • Phone: 718-960-1449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number036165643
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: