Healthcare Provider Details

I. General information

NPI: 1568734465
Provider Name (Legal Business Name): VIELINE D PHILBERT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2012
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 E 138TH ST
BRONX NY
10454-1902
US

IV. Provider business mailing address

804 E 138TH ST
BRONX NY
10454-1902
US

V. Phone/Fax

Practice location:
  • Phone: 718-665-7500
  • Fax: 718-665-4768
Mailing address:
  • Phone: 718-665-7500
  • Fax: 718-665-4768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number608466-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: