Healthcare Provider Details

I. General information

NPI: 1225459019
Provider Name (Legal Business Name): ANDREA M REID LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2013
Last Update Date: 12/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22121 JAMAICA AVE
QUEENS VILLAGE NY
11428-2015
US

IV. Provider business mailing address

1781 LINDEN BLVD APT 2R
BROOKLYN NY
11207-6634
US

V. Phone/Fax

Practice location:
  • Phone: 718-468-6925
  • Fax:
Mailing address:
  • Phone: 917-208-1013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number316955
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: