Healthcare Provider Details

I. General information

NPI: 1861650434
Provider Name (Legal Business Name): MARIE DONNA HENRY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 ISELIN AVE
BRONX NY
10471-2915
US

IV. Provider business mailing address

5050 ISELIN AVE
BRONX NY
10471-2915
US

V. Phone/Fax

Practice location:
  • Phone: 718-549-6700
  • Fax: 718-796-0758
Mailing address:
  • Phone: 718-549-6700
  • Fax: 718-796-0758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF332945-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: