Healthcare Provider Details

I. General information

NPI: 1922777341
Provider Name (Legal Business Name): MARIA VINES B.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 KNOLLWOOD RD STE 108
WHITE PLAINS NY
10603-1916
US

IV. Provider business mailing address

399 KNOLLWOOD RD STE 108
WHITE PLAINS NY
10603-1916
US

V. Phone/Fax

Practice location:
  • Phone: 225-335-8750
  • Fax:
Mailing address:
  • Phone: 225-335-8750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: