Healthcare Provider Details

I. General information

NPI: 1275153181
Provider Name (Legal Business Name): ALICE MARIAN SOWIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2020
Last Update Date: 04/21/2020
Certification Date: 04/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 N MAIN ST
SPRING VALLEY NY
10977-8968
US

IV. Provider business mailing address

775 N MAIN ST
SPRING VALLEY NY
10977-8968
US

V. Phone/Fax

Practice location:
  • Phone: 845-708-2000
  • Fax: 845-708-2040
Mailing address:
  • Phone: 845-708-2000
  • Fax: 845-708-2040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number256826-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: