Provider Demographics
NPI:1609481274
Name:NEMBHARD, AVERIL ELIZABETH (MEDICAL ASSISTANCE)
Entity Type:Individual
Prefix:
First Name:AVERIL
Middle Name:ELIZABETH
Last Name:NEMBHARD
Suffix:
Gender:F
Credentials:MEDICAL ASSISTANCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2728 PAULDING AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-4108
Mailing Address - Country:US
Mailing Address - Phone:914-758-3153
Mailing Address - Fax:718-547-4648
Practice Address - Street 1:2728 PAULDING AVE FL 1
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-4108
Practice Address - Country:US
Practice Address - Phone:914-758-3153
Practice Address - Fax:718-547-4648
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY85-2122781253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY85--2122781OtherHOME CAR SERVICE