Healthcare Provider Details

I. General information

NPI: 1033294210
Provider Name (Legal Business Name): CONSTANCE NGOZI MOFUNANYA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 GERARD AVE MORRISANIA
BRONX NY
10452-8001
US

IV. Provider business mailing address

171 GLENBROOK PKWY
ENGLEWOOD NJ
07631-2105
US

V. Phone/Fax

Practice location:
  • Phone: 718-960-2893
  • Fax:
Mailing address:
  • Phone: 201-647-7815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374T00000X
TaxonomyReligious Nonmedical Nursing Personnel
License NumberF381447
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: