=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295674968
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PRISCILLA MARY PHILIP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2026
-----------------------------------------------------
Last Update Date | 03/26/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 OLD COUNTRY RD
-----------------------------------------------------
City | MINEOLA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11501-4235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-532-4647
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 45 SCHUMACHER DR
-----------------------------------------------------
City | NEW HYDE PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11040-3605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-532-4647
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | F312591-01
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------