Healthcare Provider Details

I. General information

NPI: 1689395360
Provider Name (Legal Business Name): MRS. MIRIAM YINE HURVITZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2022
Last Update Date: 09/16/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2212 128TH ST # 2
COLLEGE POINT NY
11356-2722
US

IV. Provider business mailing address

2212 128TH ST # 2
COLLEGE POINT NY
11356-2722
US

V. Phone/Fax

Practice location:
  • Phone: 347-299-3297
  • Fax:
Mailing address:
  • Phone: 347-299-3297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: