Healthcare Provider Details

I. General information

NPI: 1972792422
Provider Name (Legal Business Name): RACHEL GEORGE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2007
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4256 BRONX BLVD STE 5
BRONX NY
10466-2673
US

IV. Provider business mailing address

4256 BRONX BLVD STE 5
BRONX NY
10466-2673
US

V. Phone/Fax

Practice location:
  • Phone: 718-515-4347
  • Fax: 718-653-8641
Mailing address:
  • Phone: 718-515-4347
  • Fax: 718-653-8641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number475434
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF342799
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: