Healthcare Provider Details

I. General information

NPI: 1952686495
Provider Name (Legal Business Name): ABIGAIL AQUINO NATIVIDAD R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2011
Last Update Date: 10/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W 168TH ST
NEW YORK NY
10032-3720
US

IV. Provider business mailing address

31 ANDERSON AVE
BERGENFIELD NJ
07621-2703
US

V. Phone/Fax

Practice location:
  • Phone: 212-342-8500
  • Fax:
Mailing address:
  • Phone: 917-981-1064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number597452
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: