Healthcare Provider Details

I. General information

NPI: 1982421863
Provider Name (Legal Business Name): CORRECTIVE HEALTHCARE A NURSE PRACTITIONER IN FAMILY HEALTH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 ROUTE 25A STE 18
MILLER PLACE NY
11764-2647
US

IV. Provider business mailing address

595 ROUTE 25A STE 18
MILLER PLACE NY
11764-2647
US

V. Phone/Fax

Practice location:
  • Phone: 631-849-1620
  • Fax:
Mailing address:
  • Phone: 631-849-1620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: VIVEN VARGA
Title or Position: OWNER
Credential: NP
Phone: 631-849-1620