Provider Demographics
NPI:1427579788
Name:FALKENSTERN, CIRAH MIRA (NP)
Entity Type:Individual
Prefix:
First Name:CIRAH
Middle Name:MIRA
Last Name:FALKENSTERN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CIRAH
Other - Middle Name:
Other - Last Name:MIRA FALKENSTERN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:630 W 168TH ST # 4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3725
Mailing Address - Country:US
Mailing Address - Phone:646-317-6041
Mailing Address - Fax:212-305-6891
Practice Address - Street 1:161 FORT WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:646-317-6041
Practice Address - Fax:212-305-6891
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR13206200363LA2200X
NY609221-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health