Healthcare Provider Details

I. General information

NPI: 1558985200
Provider Name (Legal Business Name): RINCY EAPEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2020
Last Update Date: 05/28/2020
Certification Date: 05/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 MOELLER ST
HICKSVILLE NY
11801-1933
US

IV. Provider business mailing address

77 MOELLER ST
HICKSVILLE NY
11801-1933
US

V. Phone/Fax

Practice location:
  • Phone: 586-883-0758
  • Fax:
Mailing address:
  • Phone: 586-883-0758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF345420
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: