Provider Demographics
NPI:1811260110
Name:MYRIE, EMANCIA
Entity type:Individual
Prefix:
First Name:EMANCIA
Middle Name:
Last Name:MYRIE
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 1:60 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-1600
Mailing Address - Country:US
Mailing Address - Phone:212-545-2400
Mailing Address - Fax:646-312-0481
Practice Address - Street 1:999 BLAKE AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:USA
Practice Address - Zip Code:11208
Practice Address - Country:UM
Practice Address - Phone:718-277-8303
Practice Address - Fax:718-277-4795
Is Sole Proprietor?:No
Enumeration Date:2012-02-16
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401426-1363L00000X
NY478347-1163WP0808X, 163WS0200X
NYF401426363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
NY3310009Medicare Oscar/Certification
NY331943Medicare Oscar/Certification
NY331952Medicare Oscar/Certification
NY00695941Medicaid
NYW6L111Medicare Oscar/Certification
NY331043Medicare Oscar/Certification
NYG100000410Medicare Oscar/Certification
NY331058Medicare Oscar/Certification
NY331978Medicare Oscar/Certification
NY331945Medicare Oscar/Certification
NY331944Medicare Oscar/Certification
NY331947Medicare Oscar/Certification
NY331954Medicare Oscar/Certification