Healthcare Provider Details

I. General information

NPI: 1952562951
Provider Name (Legal Business Name): PATRINA NATASHA PHILLIP M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 E 149TH ST RM 5-18
BRONX NY
10451-5504
US

IV. Provider business mailing address

1326 SAINT JOHNS PL APT 2
BROOKLYN NY
11213-3727
US

V. Phone/Fax

Practice location:
  • Phone: 718-579-5830
  • Fax: 718-579-4699
Mailing address:
  • Phone: 917-698-9923
  • Fax: 718-579-4699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number247457
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: