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General NPI Number Information
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NPI Number | 1023790532
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Entity Type | Organization
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Legal Business Name | EQUILIBRIO NURSE PRACTITIONER IN PSYCHIATRY PLLC
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Dates
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Enumeration Date | 08/03/2023
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Last Update Date | 08/17/2023
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Provider Practice Location Address
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Address Line | 246 MINEOLA BLVD
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City | MINEOLA
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State | NY
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Zip | 11501-2436
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Country | US
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Telephone | 929-630-3023
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Fax |
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Provider Business Mailing Address
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Address Line | 246 MINEOLA BLVD
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City | MINEOLA
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State | NY
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Zip | 11501-2436
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PMHNP
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Name | SEAN DELLASPERANZO
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Credential | PMHNP
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Telephone | 631-834-9847
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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