Healthcare Provider Details

I. General information

NPI: 1073331237
Provider Name (Legal Business Name): ARIANE TAGAYUNA GOZON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2024
Last Update Date: 04/05/2026
Certification Date: 04/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 YORK AVE
NEW YORK NY
10065-6007
US

IV. Provider business mailing address

625 W 164TH ST APT 31B
NEW YORK NY
10032-0607
US

V. Phone/Fax

Practice location:
  • Phone: 917-880-2206
  • Fax:
Mailing address:
  • Phone: 917-880-2206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number355066
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: