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General NPI Number Information
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NPI Number | 1093433898
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Entity Type | Organization
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Legal Business Name | ENVISION PSYCHIATRIC NURSE PRACTITIONER PLLC
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Dates
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Enumeration Date | 08/17/2022
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Last Update Date | 08/17/2022
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Provider Practice Location Address
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Address Line | 70 E SUNRISE HWY STE 500
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City | VALLEY STREAM
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State | NY
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Zip | 11581-1233
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Country | US
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Telephone | 516-988-0974
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Fax |
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Provider Business Mailing Address
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Address Line | 70 E SUNRISE HWY STE 500
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City | VALLEY STREAM
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State | NY
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Zip | 11581-1233
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Country | US
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Telephone | 516-988-0974
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Fax | 718-719-4217
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Authorized Official
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Title or Position | OWNER
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Name | MS. TAMARA GORDON
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Credential | NP
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Telephone | 516-988-0974
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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