Provider Demographics
NPI:1679904882
Name:COLEMAN, NEFETARI
Entity type:Individual
Prefix:
First Name:NEFETARI
Middle Name:
Last Name:COLEMAN
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 1:4004 CARPENTER AVE
Mailing Address - Street 2:APT 3B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-3672
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:271 NORTH AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5104
Practice Address - Country:US
Practice Address - Phone:914-576-5051
Practice Address - Fax:914-576-5021
Is Sole Proprietor?:No
Enumeration Date:2013-12-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY315180-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1578884755Medicaid