Healthcare Provider Details

I. General information

NPI: 1649884537
Provider Name (Legal Business Name): BRIDGE TO CARE NURSE PRACTITIONER IN PSYCHIATRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2020
Last Update Date: 09/08/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3005 CHURCH AVE
BROOKLYN NY
11226-4209
US

IV. Provider business mailing address

10536 AVENUE K
BROOKLYN NY
11236-3018
US

V. Phone/Fax

Practice location:
  • Phone: 347-627-6100
  • Fax:
Mailing address:
  • Phone: 347-627-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HENRIETTA O OKPALA
Title or Position: PMHNP
Credential:
Phone: 718-288-0979