Healthcare Provider Details

I. General information

NPI: 1487077475
Provider Name (Legal Business Name): VILLAGE DIAGNOSTIC & TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2014
Last Update Date: 01/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 PARK HILL AVE # 3
YONKERS NY
10701-4822
US

IV. Provider business mailing address

109 PARK HILL AVE # 3
YONKERS NY
10701-4822
US

V. Phone/Fax

Practice location:
  • Phone: 347-280-4817
  • Fax:
Mailing address:
  • Phone: 347-280-4817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DENISE BRITO
Title or Position: PATIENT SERVICE SUPERVISOR
Credential:
Phone: 212-337-9293