Healthcare Provider Details

I. General information

NPI: 1730458894
Provider Name (Legal Business Name): LOIS ANN HAQUE RN NCSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2011
Last Update Date: 12/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 HAMPTON ST
MINEOLA NY
11501-3403
US

IV. Provider business mailing address

92 BIRCH HL
ALBERTSON NY
11507-1002
US

V. Phone/Fax

Practice location:
  • Phone: 516-237-2280
  • Fax:
Mailing address:
  • Phone: 516-484-0192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number193133-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: