Healthcare Provider Details

I. General information

NPI: 1669742128
Provider Name (Legal Business Name): CATHERINE G PRYZMONT R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2011
Last Update Date: 12/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 JOHN ST
AMITYVILLE NY
11701-2930
US

IV. Provider business mailing address

37 JOHN ST
AMITYVILLE NY
11701-2930
US

V. Phone/Fax

Practice location:
  • Phone: 631-424-2900
  • Fax: 631-598-5716
Mailing address:
  • Phone: 631-424-2900
  • Fax: 631-598-5716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number308558
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: