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General NPI Number Information
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NPI Number | 1255868634
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Entity Type | Organization
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Legal Business Name | MAYA E KUNOFSKY NP PSYCHIATRY PC
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Dates
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Enumeration Date | 05/17/2017
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Last Update Date | 05/17/2017
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Provider Practice Location Address
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Address Line | 1115 BROADWAY FL 12
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City | NEW YORK
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State | NY
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Zip | 10010-3452
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Country | US
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Telephone | 646-854-5988
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Fax |
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Provider Business Mailing Address
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Address Line | 425 RIVERSIDE DR APT 3E
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City | NEW YORK
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State | NY
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Zip | 10025-7725
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Country | US
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Telephone | 917-459-3277
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MAYA KUNOFSKY
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Credential | NP
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Telephone | 646-854-5988
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 401220
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License Number State | NY
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