Healthcare Provider Details

I. General information

NPI: 1063103281
Provider Name (Legal Business Name): MARIAN RITA CAMBRIDGE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 05/18/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 E 137TH ST BRONX
BRONX NY
10454
US

IV. Provider business mailing address

730 NOBLE AVE
BRONX NY
10473-4115
US

V. Phone/Fax

Practice location:
  • Phone: 718-993-3458
  • Fax:
Mailing address:
  • Phone: 347-398-7668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number470939
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: