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General NPI Number Information
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NPI Number | 1982314035
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Entity Type | Organization
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Legal Business Name | APM NURSE PRACTITIONER IN PSYCHIATRY
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Dates
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Enumeration Date | 11/30/2022
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Last Update Date | 12/30/2022
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Provider Practice Location Address
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Address Line | 75 S BROADWAY STE 4-7584
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City | WHITE PLAINS
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State | NY
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Zip | 10601-4413
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Country | US
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Telephone | 631-388-7080
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Fax | 503-334-2497
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Provider Business Mailing Address
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Address Line | 75 S BROADWAY STE 4-7584
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City | WHITE PLAINS
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State | NY
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Zip | 10601-4413
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Country | US
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Telephone | 631-388-7080
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Fax | 503-334-2497
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Authorized Official
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Title or Position | OWNER
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Name | ALEXANDER PEGUERO-MEDRANO
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Credential |
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Telephone | 631-388-7080
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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 |
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License Number State |
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