Healthcare Provider Details

I. General information

NPI: 1669683918
Provider Name (Legal Business Name): NURTEN FIDAN P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 07/21/2023
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 6TH ST
BROOKLYN NY
11215-3609
US

IV. Provider business mailing address

1727 W 4TH ST
BROOKLYN NY
11223-1545
US

V. Phone/Fax

Practice location:
  • Phone: 718-780-3626
  • Fax:
Mailing address:
  • Phone: 718-450-1922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number010831
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: