Provider Demographics
NPI:1982314035
Name:APM NURSE PRACTITIONER IN PSYCHIATRY
Entity type:Organization
Organization Name:APM NURSE PRACTITIONER IN PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:PEGUERO-MEDRANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-388-7080
Mailing Address - Street 1:75 S BROADWAY STE 4-7584
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-4413
Mailing Address - Country:US
Mailing Address - Phone:631-388-7080
Mailing Address - Fax:503-334-2497
Practice Address - Street 1:75 S BROADWAY STE 4-7584
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-4413
Practice Address - Country:US
Practice Address - Phone:631-388-7080
Practice Address - Fax:503-334-2497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-30
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty