Healthcare Provider Details

I. General information

NPI: 1326673278
Provider Name (Legal Business Name): ASSETOU CISSE-SMITH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2020
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PELHAM PKWY S
BRONX NY
10461-1197
US

IV. Provider business mailing address

3244 FISH AVE
BRONX NY
10469-2906
US

V. Phone/Fax

Practice location:
  • Phone: 718-918-5800
  • Fax:
Mailing address:
  • Phone: 718-781-5740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF345723
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: