Healthcare Provider Details

I. General information

NPI: 1316298656
Provider Name (Legal Business Name): FAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2012
Last Update Date: 09/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4024 HUBBARD PL
BROOKLYN NY
11210-4953
US

IV. Provider business mailing address

4024 HUBBARD PL
BROOKLYN NY
11210-4953
US

V. Phone/Fax

Practice location:
  • Phone: 917-865-3482
  • Fax: 718-252-2596
Mailing address:
  • Phone: 917-865-3482
  • Fax: 718-252-2596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1942590302
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: MS. FAITH A BERNAL
Title or Position: PRESIDENT & CEO
Credential: RN
Phone: 917-865-3482