University Physicians Group

NPI 1407247430 - Nurse Practitioner - 363LF0000X

NPI Details
NPI 1407247430
Enumeration Date 02/12/2015
Last Updated 02/12/2015
Entity Type Healthcare Provider
Active Over 1 year ago
Authorized Information
Name THEODORE THEODORE
Position OWNER
Phone (718) 226-1011
Fax
Practice Location
1 EDGEWATER ST STE 704
STATEN ISLAND NY, 10305-4900, US
Phone (718) 226-1011
Fax
Business Location
1 EDGEWATER ST STE 704
STATEN ISLAND NY, 10305-4900, US
Phone (718) 226-1011
Fax
Toxanomy
Taxonomy Code 363LF0000X
License State New York
License Number F339345
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According to our database, University Physicians Group NPI is 1407247430, taxonomy code is 363LF0000X and license number is F339345, license state is located at New York. University Physicians Group physically located at 1 Edgewater St Ste 704, Staten Island NY, 10305-4900. NPI Number 1033115704 has the healthcare provider type.

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1407247430 NPI number is provided on an as is basis without warranty of any kind. 1407247430 is maintained by the National Plan & Provider Enumeration System. The contents of University Physicians Group are for informational purposes only.