Healthcare Provider Details

I. General information

NPI: 1295770113
Provider Name (Legal Business Name): MARIE-FLORE NAU-FORT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 WHITE PLAINS RD
BRONX NY
10473-2631
US

IV. Provider business mailing address

616 CASTLE HILL AVE
BRONX NY
10473-1402
US

V. Phone/Fax

Practice location:
  • Phone: 718-589-8324
  • Fax: 718-378-2880
Mailing address:
  • Phone: 718-239-9013
  • Fax: 718-794-0468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number143910
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: