Healthcare Provider Details

I. General information

NPI: 1114288289
Provider Name (Legal Business Name): JHOANNA URENA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2012
Last Update Date: 06/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16216 UNION TPKE STE 303
FRESH MEADOWS NY
11366-1960
US

IV. Provider business mailing address

1516 DECATUR ST APT. # 1L
RIDGEWOOD NY
11385-5740
US

V. Phone/Fax

Practice location:
  • Phone: 718-264-7250
  • Fax: 718-264-7922
Mailing address:
  • Phone: 718-264-7250
  • Fax: 718-264-7922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: