Healthcare Provider Details

I. General information

NPI: 1659883718
Provider Name (Legal Business Name): RITA M. FOWLER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2017
Last Update Date: 10/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 WEST HAWTHORNE AVE. SUITE 31 NEW YORK HEALTH CARE
VALLEY STREAM NY
11580
US

IV. Provider business mailing address

320 ROBINSON AVE. UNIT 203 NEW YORK HEALTH CARE
NEWBURGH NY
12550-3338
US

V. Phone/Fax

Practice location:
  • Phone: 718-375-6700
  • Fax:
Mailing address:
  • Phone: 845-569-8120
  • Fax: 845-569-8128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number242209-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: