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General NPI Number Information
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NPI Number | 1659150423
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Entity Type | Individual
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Provider Name | AERREN KUBLAL NP
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Gender | Male
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Dates
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Enumeration Date | 09/21/2023
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Last Update Date | 09/21/2023
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Provider Practice Location Address
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Address Line | 100 E 77TH ST
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City | NEW YORK
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State | NY
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Zip | 10075-1850
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Country | US
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Telephone | 212-434-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 101 SAINT ANDREWS LN - ANNEX ANNEX
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City | GLEN COVE
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State | NY
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Zip | 11542-2263
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Country | US
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Telephone | 516-674-7972
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 405337
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License Number State | NY
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