Healthcare Provider Details

I. General information

NPI: 1548799513
Provider Name (Legal Business Name): ENZINA MARIA GIBALDI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 06/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 3RD AVE
NEW YORK NY
10017-5704
US

IV. Provider business mailing address

675 3RD AVE
NEW YORK NY
10017-5704
US

V. Phone/Fax

Practice location:
  • Phone: 646-292-3073
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number724127
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: