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General NPI Number Information
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NPI Number | 1366153199
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Entity Type | Organization
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Legal Business Name | ON THE GO NP IN ADULT HEALTH
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Dates
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Enumeration Date | 12/13/2022
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Last Update Date | 12/13/2022
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Provider Practice Location Address
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Address Line | 130 S FORDHAM RD
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City | HICKSVILLE
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State | NY
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Zip | 11801-6000
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Country | US
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Telephone | 516-522-5500
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Fax |
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Provider Business Mailing Address
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Address Line | 442 S OYSTER BAY RD # 1020
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City | HICKSVILLE
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State | NY
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Zip | 11801-3515
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Country | US
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Telephone | 718-413-8168
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER/ CEO
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Name | LAURIE LUCAS
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Credential | DNP, NP-C
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Telephone | 718-413-8168
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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