Healthcare Provider Details

I. General information

NPI: 1245981406
Provider Name (Legal Business Name): MARIYA NAUMOFF FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2022
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 1ST AVE FL 2
NEW YORK NY
10016-6402
US

IV. Provider business mailing address

550 1ST AVE FL 2
NEW YORK NY
10016-6402
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-5230
  • Fax:
Mailing address:
  • Phone: 718-685-8980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF348139-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: