Healthcare Provider Details

I. General information

NPI: 1124302500
Provider Name (Legal Business Name): MARSHA A REYNOLDS-HENRY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARSHA REYNOLDS FNP-BC

II. Dates (important events)

Enumeration Date: 10/04/2011
Last Update Date: 10/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3944A PAULDING AVE
BRONX NY
10466-4713
US

IV. Provider business mailing address

3944A PAULDING AVE
BRONX NY
10466-4713
US

V. Phone/Fax

Practice location:
  • Phone: 917-723-4383
  • Fax: 347-326-8571
Mailing address:
  • Phone: 917-723-4383
  • Fax: 347-326-8571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number553414
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF343532-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: