Provider Demographics
NPI:1720770316
Name:NAVARRETE, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:NAVARRETE
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 1:59 LAGUNA LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-2482
Mailing Address - Country:US
Mailing Address - Phone:917-456-2069
Mailing Address - Fax:
Practice Address - Street 1:59 LAGUNA LN
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-2482
Practice Address - Country:US
Practice Address - Phone:917-456-2069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty