Healthcare Provider Details

I. General information

NPI: 1265841894
Provider Name (Legal Business Name): E & G HEATHCARE, N.P. IN FAMILY HEALTH P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2014
Last Update Date: 10/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 MERRYMOUNT ST
STATEN ISLAND NY
10314-4844
US

IV. Provider business mailing address

149 MERRYMOUNT ST
STATEN ISLAND NY
10314-4844
US

V. Phone/Fax

Practice location:
  • Phone: 718-698-6700
  • Fax:
Mailing address:
  • Phone: 718-698-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: EFRAT HALEVI
Title or Position: FNP
Credential:
Phone: 718-698-6700