Healthcare Provider Details

I. General information

NPI: 1457429607
Provider Name (Legal Business Name): NANCY B BROOKS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PENN PLZ 8TH FLOOR
NEW YORK NY
10119-0002
US

IV. Provider business mailing address

1 PENN PLZ 8TH FLOOR
NEW YORK NY
10119-0002
US

V. Phone/Fax

Practice location:
  • Phone: 917-364-0995
  • Fax: 212-216-6606
Mailing address:
  • Phone: 917-364-0995
  • Fax: 212-216-6606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberF340491-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: