Healthcare Provider Details

I. General information

NPI: 1699698779
Provider Name (Legal Business Name): MARISA AHRENDTS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E 18TH ST APT 5G
BROOKLYN NY
11226-7335
US

IV. Provider business mailing address

600 E 18TH ST APT 5G
BROOKLYN NY
11226-7335
US

V. Phone/Fax

Practice location:
  • Phone: 347-283-6964
  • Fax:
Mailing address:
  • Phone: 347-283-6964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number992594
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: