=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245588094
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANTHONY HENRY BAPTISTE LPN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2012
-----------------------------------------------------
Last Update Date | 08/28/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 119 EALING CT
-----------------------------------------------------
City | BRENTWOOD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11717-5621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-548-7061
-----------------------------------------------------
Fax | 631-617-6219
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 119 EALING CT
-----------------------------------------------------
City | BRENTWOOD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11717-5621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-548-7061
-----------------------------------------------------
Fax | 631-617-6219
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | 3088221
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------