Healthcare Provider Details

I. General information

NPI: 1467855486
Provider Name (Legal Business Name): MINNA NAVVAB PMHNP-BC, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2014
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 PARK AVE S
NEW YORK NY
10003-1502
US

IV. Provider business mailing address

200 VARICK ST RM 900
NEW YORK NY
10014-4893
US

V. Phone/Fax

Practice location:
  • Phone: 973-910-0580
  • Fax: 917-764-4709
Mailing address:
  • Phone: 212-620-0340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberRN241876
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number001855
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number404740
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: