Healthcare Provider Details

I. General information

NPI: 1871318774
Provider Name (Legal Business Name): TEMA NYA REGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 WELLESLEY ST STE 1
WESTON MA
02493-1571
US

IV. Provider business mailing address

25 KENILWORTH PL
BROOKLYN NY
11210-2327
US

V. Phone/Fax

Practice location:
  • Phone: 917-628-1404
  • Fax:
Mailing address:
  • Phone: 917-628-1404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number740033
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: