Healthcare Provider Details

I. General information

NPI: 1982205894
Provider Name (Legal Business Name): HAROLD FLOCKHART ADULT HEALTH NP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 CAMPUS DR
EAST SETAUKET NY
11733-1149
US

IV. Provider business mailing address

12 CAMPUS DR
EAST SETAUKET NY
11733-1149
US

V. Phone/Fax

Practice location:
  • Phone: 631-521-1683
  • Fax:
Mailing address:
  • Phone: 631-521-1683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. HAROLD JAMES FLOCKHART
Title or Position: OWNER/PRACTITIONER
Credential: NP
Phone: 631-521-1683