Healthcare Provider Details

I. General information

NPI: 1043281785
Provider Name (Legal Business Name): MARIA C BANVARD DNP, NP, MSN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 FRANKLIN AVE LOWR LEVEL
GARDEN CITY NY
11530-2926
US

IV. Provider business mailing address

1000 FRANKLIN AVE LOWR LEVEL
GARDEN CITY NY
11530-2926
US

V. Phone/Fax

Practice location:
  • Phone: 516-663-2367
  • Fax:
Mailing address:
  • Phone: 516-663-2367
  • Fax: 516-663-2746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number302783
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: