Healthcare Provider Details

I. General information

NPI: 1376818054
Provider Name (Legal Business Name): MS. IRENE DELEON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2012
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 SEAVIEW AVE
STATEN ISLAND NY
10305-3409
US

IV. Provider business mailing address

777 SEAVIEW AVE
STATEN ISLAND NY
10305-3409
US

V. Phone/Fax

Practice location:
  • Phone: 718-667-2300
  • Fax:
Mailing address:
  • Phone: 718-667-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number7277889
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number7277889
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: