Healthcare Provider Details

I. General information

NPI: 1699216986
Provider Name (Legal Business Name): MICHAEL EASTMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2017
Last Update Date: 09/29/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6938A THURSBY AVE
ARVERNE NY
11692-1138
US

IV. Provider business mailing address

6938A THURSBY AVE
ARVERNE NY
11692-1138
US

V. Phone/Fax

Practice location:
  • Phone: 347-234-1830
  • Fax: 718-213-4606
Mailing address:
  • Phone: 347-234-1830
  • Fax: 718-213-4606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number431855-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: