Healthcare Provider Details

I. General information

NPI: 1689336695
Provider Name (Legal Business Name): HAPPY FAMILY NURSE PRACTITIONER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2021
Last Update Date: 10/13/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 COLONIAL AVE
WILLISTON PARK NY
11596-1527
US

IV. Provider business mailing address

152 COLONIAL AVE
WILLISTON PARK NY
11596-1527
US

V. Phone/Fax

Practice location:
  • Phone: 347-834-1117
  • Fax:
Mailing address:
  • Phone: 347-834-1117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: YOUNJEA LEE
Title or Position: NP
Credential: NP
Phone: 347-834-1117