Provider Demographics
NPI:1790800407
Name:NATH, NOREENE
Entity Type:Individual
Prefix:
First Name:NOREENE
Middle Name:
Last Name:NATH
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 1:51-55N ROUTE 9W
Mailing Address - Street 2:
Mailing Address - City:WEST HAVERSTRAW
Mailing Address - State:NY
Mailing Address - Zip Code:10993-1195
Mailing Address - Country:US
Mailing Address - Phone:845-786-4062
Mailing Address - Fax:845-786-4526
Practice Address - Street 1:51-55N ROUTE 9W
Practice Address - Street 2:
Practice Address - City:WEST HAVERSTRAW
Practice Address - State:NY
Practice Address - Zip Code:10993-1195
Practice Address - Country:US
Practice Address - Phone:845-786-4000
Practice Address - Fax:845-786-4526
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335072363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily