Healthcare Provider Details

I. General information

NPI: 1982132346
Provider Name (Legal Business Name): MARCIA WINNS MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2017
Last Update Date: 08/18/2020
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 5TH AVE
NEW YORK NY
10029-3119
US

IV. Provider business mailing address

1595 ODELL ST APT 6A
BRONX NY
10462-7010
US

V. Phone/Fax

Practice location:
  • Phone: 212-426-3400
  • Fax: 212-426-3400
Mailing address:
  • Phone: 718-518-7532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number981288151
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: