Healthcare Provider Details

I. General information

NPI: 1508297177
Provider Name (Legal Business Name): ANDREW HENRY R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2013
Last Update Date: 12/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 ISELIN AVE
BRONX NY
10471-2915
US

IV. Provider business mailing address

5050 ISELIN AVE
BRONX NY
10471-2915
US

V. Phone/Fax

Practice location:
  • Phone: 718-549-6700
  • Fax: 718-796-0758
Mailing address:
  • Phone: 718-549-6700
  • Fax: 718-796-0758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number650445-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: