Healthcare Provider Details

I. General information

NPI: 1467798439
Provider Name (Legal Business Name): THERESA MARY GRIFFITH PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2012
Last Update Date: 12/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 1ST AVE DEPARTMENT OF PEDIATRICS
NEW YORK NY
10016-9196
US

IV. Provider business mailing address

130 MALCOLM X BLVD #914
NEW YORK NY
10026-2503
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-3005
  • Fax: 646-501-6933
Mailing address:
  • Phone: 917-472-7133
  • Fax: 917-472-7133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF381410
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: