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General NPI Number Information
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NPI Number | 1376222760
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Entity Type | Organization
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Legal Business Name | LOTUS NP IN PSYCHIATRY PLLC
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Dates
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Enumeration Date | 07/13/2023
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Last Update Date | 07/13/2023
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Provider Practice Location Address
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Address Line | 555 BROADHOLLOW RD STE 305
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City | MELVILLE
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State | NY
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Zip | 11747-5018
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Country | US
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Telephone | 646-995-2360
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 509
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City | DEER PARK
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State | NY
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Zip | 11729-0509
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Country | US
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Telephone | 718-764-3164
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | JATOOPON MALDONADO
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Credential | PMHNP
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Telephone | 718-764-3164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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