Basic Information
| Provider Information | |||||||||
| NPI: | 1689044364 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GERMANO | ||||||||
| FirstName: | MIRNA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | AG-NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3636 33RD ST STE 306 | ||||||||
| Address2: | |||||||||
| City: | LONG ISLAND CITY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 111062329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8444034325 | ||||||||
| FaxNumber: | 4246250010 | ||||||||
| Practice Location | |||||||||
| Address1: | 3636 33RD ST STE 306 | ||||||||
| Address2: | |||||||||
| City: | LONG ISLAND CITY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 111062329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8444034325 | ||||||||
| FaxNumber: | 4246250010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2015 | ||||||||
| LastUpdateDate: | 05/23/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 307492 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.