Healthcare Provider Details

I. General information

NPI: 1386947778
Provider Name (Legal Business Name): GERICARE PLUS NP ADULT HEALTH & NP GERONTOLOGY HOUSE CALLS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2010
Last Update Date: 12/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

656 LENOX RD
NORTH BALDWIN NY
11510-1019
US

IV. Provider business mailing address

656 LENOX RD
NORTH BALDWIN NY
11510-1019
US

V. Phone/Fax

Practice location:
  • Phone: 917-929-3388
  • Fax:
Mailing address:
  • Phone: 917-929-3388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number302642
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number340543
License Number StateNY

VIII. Authorized Official

Name: GINA LUCIEN
Title or Position: NURSE PRACTIONER IN ADULT HEALTH
Credential: ANP-C
Phone: 917-929-3388