Healthcare Provider Details

I. General information

NPI: 1659779726
Provider Name (Legal Business Name): EARLYN KIT BOSTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2014
Last Update Date: 12/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 VANDALIA AVE 2 ND FLOOR
BROOKLYN NY
11239-2809
US

IV. Provider business mailing address

550 VANDALIA AVENUE 2 ND FLOOR
BROOKLYN NY
11239
US

V. Phone/Fax

Practice location:
  • Phone: 347-564-2673
  • Fax:
Mailing address:
  • Phone: 347-564-2673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number22532935
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number30306740
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: