Healthcare Provider Details

I. General information

NPI: 1801040183
Provider Name (Legal Business Name): LELLIETH PARKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2008
Last Update Date: 09/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 EASTCHESTER RD
BRONX NY
10469-1670
US

IV. Provider business mailing address

3515 EASTCHESTER RD
BRONX NY
10469-1670
US

V. Phone/Fax

Practice location:
  • Phone: 718-944-1776
  • Fax: 718-944-1779
Mailing address:
  • Phone: 718-944-1776
  • Fax: 718-944-1779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number536839
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: