=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215161120
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NESLIE LESLIE PIERRE-LOUIS PA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2009
-----------------------------------------------------
Last Update Date | 03/08/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25902 148TH AVE
-----------------------------------------------------
City | ROSEDALE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11422-2902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-712-2606
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25902 148TH AVE
-----------------------------------------------------
City | ROSEDALE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11422-2902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-712-2606
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 011145
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------