Healthcare Provider Details

I. General information

NPI: 1609948165
Provider Name (Legal Business Name): CALEEN MARIA WARREN FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 SELWYN AVE
BRONX NY
10457-7626
US

IV. Provider business mailing address

11729 230TH ST
CAMBRIA HEIGHTS NY
11411-1806
US

V. Phone/Fax

Practice location:
  • Phone: 718-466-7202
  • Fax: 718-466-7288
Mailing address:
  • Phone: 718-949-6588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF332907
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: