Healthcare Provider Details

I. General information

NPI: 1639794720
Provider Name (Legal Business Name): ADRIENNE MARGAUX FAVORITO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 BROADWAY
NEW YORK NY
10032-1559
US

IV. Provider business mailing address

104 MASSACHUSETTS AVE
CONGERS NY
10920-2504
US

V. Phone/Fax

Practice location:
  • Phone: 845-499-8821
  • Fax:
Mailing address:
  • Phone: 845-499-8821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number689315
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberF350497
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: