Basic Information
| Provider Information | |||||||||
| NPI: | 1437826906 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DENTINO | ||||||||
| FirstName: | MAURA | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 274 MADISON AVE RM 1501 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100160701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122031773 | ||||||||
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| Practice Location | |||||||||
| Address1: | 274 MADISON AVE RM 1501 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100160701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122031773 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2021 | ||||||||
| LastUpdateDate: | 01/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 717643 | NY | N | Nursing Service Providers | Registered Nurse | 363LP0808X | 403663 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.