Healthcare Provider Details

I. General information

NPI: 1679752307
Provider Name (Legal Business Name): MARGARITA POTHEMONT REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 10/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 INWOOD AVE
BRONX NY
10452-2001
US

IV. Provider business mailing address

3 PARK LN APT. 1G
MOUNT VERNON NY
10552-3451
US

V. Phone/Fax

Practice location:
  • Phone: 718-299-5500
  • Fax: 718-299-1420
Mailing address:
  • Phone: 914-699-5274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number395324
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: