Provider Demographics
NPI:1689069742
Name:LARRY, NASIRATU
Entity Type:Individual
Prefix:
First Name:NASIRATU
Middle Name:
Last Name:LARRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 DAVIS AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-1034
Mailing Address - Country:US
Mailing Address - Phone:914-681-2560
Mailing Address - Fax:914-681-2090
Practice Address - Street 1:41 DAVIS AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1034
Practice Address - Country:US
Practice Address - Phone:914-681-2560
Practice Address - Fax:914-681-2590
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-05
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY294925207R00000X
282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine