Healthcare Provider Details

I. General information

NPI: 1285939744
Provider Name (Legal Business Name): LUCINDA SEONGBAE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2011
Last Update Date: 01/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 NOSTRAND AVE STE 2 SUITE 2
BROOKLYN NY
11226-7181
US

IV. Provider business mailing address

1809 NOSTRAND AVE STE 2 SUITE 2
BROOKLYN NY
11226-7181
US

V. Phone/Fax

Practice location:
  • Phone: 718-421-4224
  • Fax: 718-421-4774
Mailing address:
  • Phone: 718-421-4224
  • Fax: 718-421-4774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number638584-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: