Healthcare Provider Details

I. General information

NPI: 1447669643
Provider Name (Legal Business Name): GERALDINE MICHEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2014
Last Update Date: 08/13/2014
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

10444 205TH ST
SAINT ALBANS NY
11412-1410
US

V. Phone/Fax

Practice location:
  • Phone: 516-390-9640
  • Fax: 516-390-9650
Mailing address:
  • Phone: 718-776-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number306013
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: