Healthcare Provider Details

I. General information

NPI: 1609283795
Provider Name (Legal Business Name): CECELIA CAREW MA, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2014
Last Update Date: 07/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 W KINGSBRIDGE RD
BRONX NY
10468-3904
US

IV. Provider business mailing address

30 EHRBAR AVENUE SUITE #201
MOUNT VERNON NY
10552-3673
US

V. Phone/Fax

Practice location:
  • Phone: 718-584-9000
  • Fax:
Mailing address:
  • Phone: 914-497-0984
  • Fax: 718-289-6059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number285020
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: