Healthcare Provider Details

I. General information

NPI: 1427962265
Provider Name (Legal Business Name): INNER GLOW FAMILY NP &RN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 MAIN ST
NYACK NY
10960-3001
US

IV. Provider business mailing address

173 MAIN ST
NYACK NY
10960-3001
US

V. Phone/Fax

Practice location:
  • Phone: 845-533-5910
  • Fax: 845-533-5910
Mailing address:
  • Phone: 845-533-5910
  • Fax: 845-533-5910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: YVELINE ALTEON
Title or Position: OWNER
Credential:
Phone: 845-533-5910