MEDICARE: BETSY NEGRON CPNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	F380500	NY

General Provider Information

NPI Number	:	1790148799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETSY NEGRON CPNP

Provider Business Mailing Address
First Line	:	PO BOX 518
Second Line	:
City	:	BRONXVILLE
State	:	NY
Zip	:	10708-0518
Country	:	US
Telephone Number	:	718-329-2275
Fax Number	:	718-329-2276

Provider Business Practice Location Address
First Line	:	3050 GRAND CONCOURSE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458-1306
Country	:	US
Telephone Number	:	718-329-2275
Fax Number	:	718-329-2276

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2016
Last Update Date	:	03/29/2016

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