Healthcare Provider Details

I. General information

NPI: 1023108826
Provider Name (Legal Business Name): PAULETTE WALD-CAGAN RNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MMC - DEPARTMENT OF MEDICINE 111 EAST 210TH STREET
BRONX NY
10467
US

IV. Provider business mailing address

58 ELM RD
BRIARCLIFF MANOR NY
10510-2224
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-6722
  • Fax:
Mailing address:
  • Phone: 718-920-6722
  • Fax: 718-655-9672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF330313
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: