Healthcare Provider Details

I. General information

NPI: 1932304318
Provider Name (Legal Business Name): HERMINIA SARA OSTRYNSKI LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 YOUNGS AVE
CALVERTON NY
11933-1429
US

IV. Provider business mailing address

82 YOUNGS AVE
CALVERTON NY
11933-1429
US

V. Phone/Fax

Practice location:
  • Phone: 631-369-7446
  • Fax:
Mailing address:
  • Phone: 631-369-7446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number105314
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: