Healthcare Provider Details

I. General information

NPI: 1174123731
Provider Name (Legal Business Name): NOURAN ABOELREGAL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2020
Last Update Date: 10/31/2020
Certification Date: 10/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1470 MADISON AVE FL 4
NEW YORK NY
10029-6542
US

IV. Provider business mailing address

20 WATERSIDE PLZ APT 10A
NEW YORK NY
10010-2684
US

V. Phone/Fax

Practice location:
  • Phone: 212-824-8824
  • Fax:
Mailing address:
  • Phone: 917-626-5843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number052505
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: