Healthcare Provider Details

I. General information

NPI: 1417861691
Provider Name (Legal Business Name): NEELAWATIE TULSIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 W PARK AVE
LONG BEACH NY
11561-3241
US

IV. Provider business mailing address

309 W PARK AVE
LONG BEACH NY
11561-3241
US

V. Phone/Fax

Practice location:
  • Phone: 516-854-5400
  • Fax: 516-854-5300
Mailing address:
  • Phone: 516-854-5400
  • Fax: 516-854-5300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number343007-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: