Provider Demographics
NPI:1710200050
Name:MUTO-WURPEL, MARIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:MUTO-WURPEL
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 1:100 W KINGSBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-3961
Mailing Address - Country:US
Mailing Address - Phone:718-410-1288
Mailing Address - Fax:718-410-1580
Practice Address - Street 1:100 W KINGSBRIDGE RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-3961
Practice Address - Country:US
Practice Address - Phone:718-410-1288
Practice Address - Fax:718-410-1580
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040859-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist