Healthcare Provider Details

I. General information

NPI: 1952293748
Provider Name (Legal Business Name): NADINE ANTOINETTE CROSDALE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5951 RIVERDALE AVE UNIT 185
BRONX NY
10471-4307
US

IV. Provider business mailing address

5951 RIVERDALE AVE UNIT 185
BRONX NY
10471-4307
US

V. Phone/Fax

Practice location:
  • Phone: 347-327-7244
  • Fax:
Mailing address:
  • Phone: 347-327-7244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number14890
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number407244
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number10.164358
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number699581
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: