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General NPI Number Information
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NPI Number | 1295102416
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Entity Type | Individual
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Provider Name | INDRA WARREN
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Gender | Female
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Dates
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Enumeration Date | 08/24/2015
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Last Update Date | 08/24/2015
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Provider Practice Location Address
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Address Line | 1111 AMSTERDAM AVE GME, MT. SINAI ST. LUKE'S, PLANT BUILDING, GROUND FLOOR
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City | NEW YORK
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State | NY
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Zip | 10025-1716
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Country | US
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Telephone | 212-523-2154
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Fax |
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Provider Business Mailing Address
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Address Line | 57 W 75TH ST APT 11D
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City | NEW YORK
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State | NY
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Zip | 10023-2010
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Country | US
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Telephone | 647-502-5277
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 281415
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License Number State | NY
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