Healthcare Provider Details

I. General information

NPI: 1437517885
Provider Name (Legal Business Name): KETSIA NOEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2016
Last Update Date: 01/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 CLINTON ST
HEMPSTEAD NY
11550-4281
US

IV. Provider business mailing address

612 LEONARD AVE
UNIONDALE NY
11553-2525
US

V. Phone/Fax

Practice location:
  • Phone: 516-933-0485
  • Fax: 516-933-1923
Mailing address:
  • Phone: 516-385-6278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number2257791
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: