Healthcare Provider Details

I. General information

NPI: 1770845604
Provider Name (Legal Business Name): AL. PAUL LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2012
Last Update Date: 06/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130-20 89TH RD
RICHMOND HILLS NY
11418
US

IV. Provider business mailing address

447 CLARENDON RD
UNIONDALE NY
11553-2105
US

V. Phone/Fax

Practice location:
  • Phone: 718-441-8913
  • Fax: 718-846-9064
Mailing address:
  • Phone: 516-860-7901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number233033
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: