1528294964 NPI number — MRS. MARIA B FENTON-KERIMIAN NURSE PRACTITIONER

Table of content: MRS. MARIA B FENTON-KERIMIAN NURSE PRACTITIONER (NPI 1528294964)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528294964 NPI number — MRS. MARIA B FENTON-KERIMIAN NURSE PRACTITIONER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FENTON-KERIMIAN
Provider First Name:
MARIA
Provider Middle Name:
B
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NURSE PRACTITIONER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528294964
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/29/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
160 EAST 34TH STREET
Provider Second Line Business Mailing Address:
LL-144
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-731-5035
Provider Business Mailing Address Fax Number:
212-731-5516

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
160 E 34TH ST
Provider Second Line Business Practice Location Address:
LL-144
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10016-4744
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-731-5035
Provider Business Practice Location Address Fax Number:
212-731-5516
Provider Enumeration Date:
05/29/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  303783 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)