Healthcare Provider Details

I. General information

NPI: 1295867471
Provider Name (Legal Business Name): CHONA BALAUAG ARENAS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 02/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15905 UNION TPKE
FRESH MEADOWS NY
11366-1950
US

IV. Provider business mailing address

1159 TUSK LN
WANTAGH NY
11793-2732
US

V. Phone/Fax

Practice location:
  • Phone: 718-906-6700
  • Fax: 718-906-6814
Mailing address:
  • Phone: 516-705-1353
  • Fax: 516-705-3575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF333942
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: