Healthcare Provider Details

I. General information

NPI: 1336729227
Provider Name (Legal Business Name): NATALIE LUENGO MCCONNELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GUSTAVE L LEVY PL # 1149
NEW YORK NY
10029-6504
US

IV. Provider business mailing address

1 GUSTAVE L LEVY PL # 1149
NEW YORK NY
10029-6504
US

V. Phone/Fax

Practice location:
  • Phone: 212-824-8069
  • Fax:
Mailing address:
  • Phone: 212-824-8069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number343005
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: