Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | F400446 | NY |
NPI | 1033208780 |
---|---|
Provider Name | Mindy S Loren-Weiner |
First Address | Fresh Meadows, NY 11365-3512 |
Second Address | Fresh Meadows, NY 11365-3512 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 20/08/2007 |