Healthcare Provider Details

I. General information

NPI: 1326487372
Provider Name (Legal Business Name): MS. TINA TONGNZOCK MUNZU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2013
Last Update Date: 06/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 E 3RD ST
NEW YORK NY
10009-7813
US

IV. Provider business mailing address

4325 44TH ST APT # D9
SUNNYSIDE NY
11104-4654
US

V. Phone/Fax

Practice location:
  • Phone: 212-477-8500
  • Fax:
Mailing address:
  • Phone: 917-334-0854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number606869
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: