Healthcare Provider Details

I. General information

NPI: 1265872048
Provider Name (Legal Business Name): KAREN LOUISE O'BRIEN ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2013
Last Update Date: 06/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PORT WASHINGTON BLVD
ROSLYN NY
11576-1347
US

IV. Provider business mailing address

219 BEDELL TER
WEST HEMPSTEAD NY
11552-2444
US

V. Phone/Fax

Practice location:
  • Phone: 516-562-6000
  • Fax:
Mailing address:
  • Phone: 516-489-5499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF305840
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: