Provider Demographics
NPI:1194792465
Name:MURRAY, GLORIA LORETTA (CNM)
Entity type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:LORETTA
Last Name:MURRAY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1831 EDENWALD AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-2222
Mailing Address - Country:US
Mailing Address - Phone:718-324-4410
Mailing Address - Fax:917-529-5718
Practice Address - Street 1:2847 WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-3008
Practice Address - Country:US
Practice Address - Phone:718-220-3076
Practice Address - Fax:917-529-5718
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-04
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF000655-1367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1827063Medicaid
NYS68137Medicare UPIN
NYM6M641Medicare ID - Type Unspecified