Healthcare Provider Details

I. General information

NPI: 1801109491
Provider Name (Legal Business Name): HEALTH CARE FOR ALL, NP IN ADULT HEALTH, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2010
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13876 QUEENS BLVD 1ST FLOOR
BRIARWOOD NY
11435-2930
US

IV. Provider business mailing address

13878 QUEENS BLVD 1ST FLOOR
BRIARWOOD NY
11435-2930
US

V. Phone/Fax

Practice location:
  • Phone: 718-850-6345
  • Fax: 718-526-7971
Mailing address:
  • Phone: 718-850-6345
  • Fax: 718-526-7971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License NumberF304465
License Number StateNY

VIII. Authorized Official

Name: LEONID KOL
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 718-850-6345