Healthcare Provider Details

I. General information

NPI: 1053136465
Provider Name (Legal Business Name): YESENIA ALTAGRACIA NEGRON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1241 ZEREGA AVE
BRONX NY
10462-5421
US

IV. Provider business mailing address

140 BENCHLEY PL APT 19J
BRONX NY
10475-3551
US

V. Phone/Fax

Practice location:
  • Phone: 347-547-7211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: