Provider Demographics
NPI:1932357167
Name:NYURENBERG, ALLA (RPH)
Entity Type:Individual
Prefix:
First Name:ALLA
Middle Name:
Last Name:NYURENBERG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2511 AVENUE U
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4934
Mailing Address - Country:US
Mailing Address - Phone:718-891-7900
Mailing Address - Fax:718-891-5310
Practice Address - Street 1:2511 AVENUE U
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4934
Practice Address - Country:US
Practice Address - Phone:718-891-7900
Practice Address - Fax:718-891-5310
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044347183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02510754Medicaid
NY5106140001Medicare NSC