Healthcare Provider Details

I. General information

NPI: 1063721157
Provider Name (Legal Business Name): NP:MOBILE NY FAMILY & PSYCHIATRIC HOUSE CALL SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2010
Last Update Date: 09/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 WALNUT ST
WEST HEMPSTEAD NY
11552-2027
US

IV. Provider business mailing address

30 WALNUT ST
WEST HEMPSTEAD NY
11552-2027
US

V. Phone/Fax

Practice location:
  • Phone: 516-495-0174
  • Fax: 888-251-8186
Mailing address:
  • Phone: 516-495-0174
  • Fax: 888-251-8186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF333307
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number400828-1
License Number StateNY

VIII. Authorized Official

Name: MR. RONALD DINGWELL
Title or Position: CEO
Credential: FNP
Phone: 516-495-0174