Provider Demographics
NPI:1508130881
Name:WARREN, CYNTHIA ELAINE (PHYISICAIN ASSISTANT)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:ELAINE
Last Name:WARREN
Suffix:
Gender:F
Credentials:PHYISICAIN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 GOLD ST
Mailing Address - Street 2:APT 3403
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-3055
Mailing Address - Country:US
Mailing Address - Phone:718-224-9094
Mailing Address - Fax:
Practice Address - Street 1:2308 30TH AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-3494
Practice Address - Country:US
Practice Address - Phone:718-224-9094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-03
Last Update Date:2012-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005459363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical