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General NPI Number Information
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NPI Number | 1417317736
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Entity Type | Organization
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Legal Business Name | DEPARTMENT OF HEALTH
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Dates
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Enumeration Date | 02/29/2016
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Last Update Date | 02/29/2016
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Provider Practice Location Address
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Address Line | 111 N TERRACE AVE 2ND FLOOR
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City | MOUNT VERNON
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State | NY
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Zip | 10550-1808
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Country | US
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Telephone | 914-664-1478
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Fax | 914-664-1478
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Provider Business Mailing Address
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Address Line | 111 N TERRACE AVE 2ND FLOOR
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City | MOUNT VERNON
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State | NY
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Zip | 10550-1808
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Country | US
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Telephone | 914-664-1478
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Fax | 914-664-1478
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Authorized Official
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Title or Position | STAFF NURSE
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Name | MISS MARCIA MARIE PHILLIPS
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Credential | RN
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Telephone | 914-664-1478
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 484334
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License Number State | NY
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