Healthcare Provider Details

I. General information

NPI: 1659317543
Provider Name (Legal Business Name): CYNTHIA LEE FORREST NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 GUY PARK AVE
AMSTERDAM NY
12010-1054
US

IV. Provider business mailing address

307 S EVERGREEN AVE
WOODBURY NJ
08096-2739
US

V. Phone/Fax

Practice location:
  • Phone: 518-841-7237
  • Fax: 518-841-3819
Mailing address:
  • Phone: 856-686-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF332290
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: