Healthcare Provider Details

I. General information

NPI: 1164867982
Provider Name (Legal Business Name): JANET LATTAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2013
Last Update Date: 05/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 HIGHLAND AVE OTISVILLE
OTISVILLE NY
10963-2346
US

IV. Provider business mailing address

17 HIGHLAND AVE OTISVILLE
OTISVILLE NY
10963-2346
US

V. Phone/Fax

Practice location:
  • Phone: 845-412-5413
  • Fax: 845-412-6035
Mailing address:
  • Phone: 845-412-5413
  • Fax: 845-412-6035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number533277-1
License Number StateNY

VIII. Authorized Official

Name: MISS JANET F LATTAN I
Title or Position: OWNERSHIP
Credential: REGISTERED NURSE
Phone: 845-412-5413