Healthcare Provider Details

I. General information

NPI: 1831956457
Provider Name (Legal Business Name): TEMITOPE BRANCO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/29/2024
Last Update Date: 04/13/2024
Certification Date: 04/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11835 QUEENS BLVD STE 400
FOREST HILLS NY
11375-7211
US

IV. Provider business mailing address

41 EDDIE AVE
NORTH BABYLON NY
11703
US

V. Phone/Fax

Practice location:
  • Phone: 646-722-7610
  • Fax:
Mailing address:
  • Phone: 631-748-0318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number827801
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: