Healthcare Provider Details

I. General information

NPI: 1982379897
Provider Name (Legal Business Name): DORCAS PRISCILLA BUMBURY-MANGAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2021
Last Update Date: 08/12/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1057 E 231ST ST
BRONX NY
10466-4805
US

IV. Provider business mailing address

1057 E 231ST ST
BRONX NY
10466-4805
US

V. Phone/Fax

Practice location:
  • Phone: 347-387-2277
  • Fax:
Mailing address:
  • Phone: 347-387-2277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF341710-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: