Healthcare Provider Details

I. General information

NPI: 1881962827
Provider Name (Legal Business Name): TANYA RECALL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2011
Last Update Date: 12/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 E 161ST ST
BRONX NY
10451-3512
US

IV. Provider business mailing address

790 CONCOURSE VLG W APT 11C
BRONX NY
10451-3846
US

V. Phone/Fax

Practice location:
  • Phone: 718-993-3397
  • Fax:
Mailing address:
  • Phone: 646-554-0402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number456207
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: