Healthcare Provider Details

I. General information

NPI: 1487720249
Provider Name (Legal Business Name): ANN CHRISTINE NYLUND DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 FASHION AVE STE 1004
NEW YORK NY
10123-1004
US

IV. Provider business mailing address

504 COUDERT PL
WYCKOFF NJ
07481-1015
US

V. Phone/Fax

Practice location:
  • Phone: 212-564-2331
  • Fax: 212-564-7081
Mailing address:
  • Phone: 201-560-0179
  • Fax: 201-560-0189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN005454
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: