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General NPI Number Information
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NPI Number | 1891830709
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Entity Type | Individual
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Provider Name | RENIE EIS PNP
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Gender | Female
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 11/29/2012
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Provider Practice Location Address
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Address Line | 4781 BROADWAY
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City | NEW YORK
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State | NY
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Zip | 10034-4915
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Country | US
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Telephone | 212-304-6922
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Fax | 212-304-6924
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Provider Business Mailing Address
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Address Line | 22 LANCASTER CT APT B
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City | WAYNE
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State | NJ
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Zip | 07470-7820
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Country | US
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Telephone | 973-839-6547
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 380052
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License Number State | NY
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