Healthcare Provider Details

I. General information

NPI: 1043527880
Provider Name (Legal Business Name): SOPHRONIA LARIG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2010
Last Update Date: 08/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 1ST PL 1ST FLOOR
BROOKLYN NY
11231-3465
US

IV. Provider business mailing address

11 1ST PL 1ST FLOOR
BROOKLYN NY
11231-3465
US

V. Phone/Fax

Practice location:
  • Phone: 718-596-0609
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number42-420272
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: