Healthcare Provider Details

I. General information

NPI: 1164383501
Provider Name (Legal Business Name): TYLER FARROW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 E 160TH ST FL 2
BRONX NY
10456-7898
US

IV. Provider business mailing address

760 E 160TH ST FL 2
BRONX NY
10456-7898
US

V. Phone/Fax

Practice location:
  • Phone: 646-298-6157
  • Fax:
Mailing address:
  • Phone: 646-298-6157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCRPA-P-8784
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: