Healthcare Provider Details

I. General information

NPI: 1508535030
Provider Name (Legal Business Name): MAUREEN URENA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 09/08/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 W 42ND ST APT 12G
NEW YORK NY
10036-2025
US

IV. Provider business mailing address

620 W 42ND ST APT 12G
NEW YORK NY
10036-2025
US

V. Phone/Fax

Practice location:
  • Phone: 191-744-3382
  • Fax:
Mailing address:
  • Phone: 917-443-3828
  • Fax:

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: