Healthcare Provider Details

I. General information

NPI: 1851870638
Provider Name (Legal Business Name): DARRYL LAHON RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2018
Last Update Date: 08/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 PLAZA AVE
RENSSELAER NY
12144-9662
US

IV. Provider business mailing address

PO BOX 1114
SCHENECTADY NY
12301-1114
US

V. Phone/Fax

Practice location:
  • Phone: 518-986-1066
  • Fax:
Mailing address:
  • Phone: 518-986-1066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number513461
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: