Healthcare Provider Details

I. General information

NPI: 1639577869
Provider Name (Legal Business Name): GEORGINA M PUENTE R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2014
Last Update Date: 12/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 ALEXANDER AVENUE
YONKERS NY
10704
US

IV. Provider business mailing address

73 ALEXANDER AVE
YONKERS NY
10704-4229
US

V. Phone/Fax

Practice location:
  • Phone: 914-924-1244
  • Fax:
Mailing address:
  • Phone: 914-924-1244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number409015
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: