Healthcare Provider Details

I. General information

NPI: 1144049263
Provider Name (Legal Business Name): RENA N PLYMOUTH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1073 E 43RD ST
BROOKLYN NY
11210-3525
US

IV. Provider business mailing address

1073 E 43RD ST
BROOKLYN NY
11210-3525
US

V. Phone/Fax

Practice location:
  • Phone: 646-573-7132
  • Fax:
Mailing address:
  • Phone: 646-573-7132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number79065101
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: