Healthcare Provider Details

I. General information

NPI: 1467761189
Provider Name (Legal Business Name): ADRIAL A LOBELO DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 SEAVIEW AVE
STATEN ISLAND NY
10305-3409
US

IV. Provider business mailing address

8801 5TH AVE UNIT 90613
BROOKLYN NY
11209-5966
US

V. Phone/Fax

Practice location:
  • Phone: 646-535-1276
  • Fax:
Mailing address:
  • Phone: 646-535-1276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number401353
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number582529
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: