Healthcare Provider Details

I. General information

NPI: 1366703126
Provider Name (Legal Business Name): LORENZA NUNEZ MSED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2012
Last Update Date: 06/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 FIFTH AVENUE NORTHSIDE CENTER FOR CHILD DEVELOPMENT
NEW YORK NY
10029
US

IV. Provider business mailing address

1301 FIFTH AVENUE
NEW YORK NY
10029
US

V. Phone/Fax

Practice location:
  • Phone: 212-426-3400
  • Fax: 917-484-4433
Mailing address:
  • Phone: 212-426-3400
  • Fax: 917-484-4433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: