Healthcare Provider Details

I. General information

NPI: 1275339038
Provider Name (Legal Business Name): NATALIA RADIONOVNA TEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2025
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2148 OCEAN AVE STE 402
BROOKLYN NY
11229-1487
US

IV. Provider business mailing address

2547 E 12TH ST APT 1A
BROOKLYN NY
11235-5056
US

V. Phone/Fax

Practice location:
  • Phone: 718-975-7533
  • Fax: 718-975-7530
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF353002
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: