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General NPI Number Information
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NPI Number | 1194975524
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Entity Type | Organization
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Legal Business Name | PRIMARY CARE NP IN FAMILY HEALTH AND ADULT HEALTH OF NEW YORK PLLC
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Dates
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Enumeration Date | 09/22/2008
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Last Update Date | 02/02/2011
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Provider Practice Location Address
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Address Line | 130 ROSE AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10306-2241
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Country | US
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Telephone | 718-980-1553
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Fax |
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Provider Business Mailing Address
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Address Line | 130 ROSE AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10306-2241
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Country | US
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Telephone | 718-980-1553
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. VIRGINIA NELSON
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Credential | NP
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Telephone | 718-980-1553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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