Provider Demographics
NPI:1114634359
Name:GEORGE, RENY THUNDIL (DNP)
Entity Type:Individual
Prefix:DR
First Name:RENY
Middle Name:THUNDIL
Last Name:GEORGE
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:MS
Other - First Name:RENY
Other - Middle Name:
Other - Last Name:VARUGHESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, DNP, FNP-BC
Mailing Address - Street 1:1468 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6508
Mailing Address - Country:US
Mailing Address - Phone:212-241-5881
Mailing Address - Fax:
Practice Address - Street 1:1468 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6508
Practice Address - Country:US
Practice Address - Phone:212-241-5881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY350802363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily