Provider Demographics
NPI:1467798439
Name:GRIFFITH, THERESA MARY (PNP)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:MARY
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:PNP
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Mailing Address - Street 1:130 MALCOLM X BLVD
Mailing Address - Street 2:#914
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-2503
Mailing Address - Country:US
Mailing Address - Phone:917-472-7133
Mailing Address - Fax:917-472-7133
Practice Address - Street 1:462 1ST AVE
Practice Address - Street 2:DEPARTMENT OF PEDIATRICS
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-9196
Practice Address - Country:US
Practice Address - Phone:212-263-3005
Practice Address - Fax:646-501-6933
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NYF381410363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics