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Provider Information for 1194239632

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: FEMALE

Individual NPI: 1194239632

Calendar   Last Updated:  2018-09-05
  Certification Date: 


Name Value
NPI 1194239632
Enumeration Date 2017-11-20
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 630 FLUSHING AVE
BROOKLYN, NY 11206-5026
United States

Phone: | Fax:
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Primary Practice Address 630 FLUSHING AVE
United States

Phone: 718-387-7888 | Fax:
View Map External Link
Secondary Practice Address 41 UNDERHILL RD
MIDDLETOWN, NY 10940-9442
United States

Phone: 845-642-6542 | Fax:
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Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 164W00000X - Licensed Practical Nurse NY 292155