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NPI Code Detail

MEDICARE: GHISTEINE FREDERIC

MEDICARE: GHISTEINE FREDERIC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164W00000XLicensed Practical Nurse300311-1NY

General Provider Information

NPI Number : 1578873238
Entity Type Code : Individual
Provider Name (Legal Business Name) : GHISTEINE FREDERIC
Provider Business Mailing Address
First Line : 1243 BROOKLYN AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11203
Country : US
Telephone Number : 646-363-8275
Fax Number :
Provider Business Practice Location Address
First Line : 1243 BROOKLYN AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11203
Country : US
Telephone Number : 646-363-8275
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/15/2010
Last Update Date : 10/15/2010

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Directions to “ GHISTEINE FREDERIC ” Practice Location

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