Healthcare Provider Details

I. General information

NPI: 1245680628
Provider Name (Legal Business Name): GORATHY OPARA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2016
Last Update Date: 06/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 BROADWAY
AMITYVILLE NY
11701-2716
US

IV. Provider business mailing address

365 BROADWAY
AMITYVILLE NY
11701-2716
US

V. Phone/Fax

Practice location:
  • Phone: 631-608-8523
  • Fax: 631-608-8527
Mailing address:
  • Phone: 631-608-8523
  • Fax: 631-608-8527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number324560
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: