Healthcare Provider Details

I. General information

NPI: 1891023966
Provider Name (Legal Business Name): LENORE CHIRIBOGA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2009
Last Update Date: 11/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

443 39TH ST 2FL.
BROOKLYN NY
11232-2907
US

IV. Provider business mailing address

443 39TH ST 2FL.
BROOKLYN NY
11232-2907
US

V. Phone/Fax

Practice location:
  • Phone: 718-431-8725
  • Fax: 718-431-8709
Mailing address:
  • Phone: 718-431-8725
  • Fax: 718-431-8709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number618841-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: