Healthcare Provider Details

I. General information

NPI: 1497044408
Provider Name (Legal Business Name): BEAUVAL ARISTIDE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2011
Last Update Date: 11/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MIMOSA ST
MILLER PLACE NY
11764-3038
US

IV. Provider business mailing address

1357 KIEFER AVE
ELMONT NY
11003-3232
US

V. Phone/Fax

Practice location:
  • Phone: 347-413-9976
  • Fax:
Mailing address:
  • Phone: 347-417-3681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF402521-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number632195
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: