Healthcare Provider Details

I. General information

NPI: 1396104147
Provider Name (Legal Business Name): JUN ROSE ABELLA F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2016
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 WALL STREET
NEW YORK NY
10005
US

IV. Provider business mailing address

40 WALL STREET
NEW YORK NY
10005
US

V. Phone/Fax

Practice location:
  • Phone: 888-535-6963
  • Fax:
Mailing address:
  • Phone: 212-857-1922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number339259
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: