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General NPI Number Information
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NPI Number | 1386300796
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Entity Type | Organization
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Legal Business Name | FAMILY HEALTH NURSE PRACTITIONER OF ELMONT PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 11/10/2021
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Last Update Date | 11/10/2021
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Provider Practice Location Address
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Address Line | 135 ROCKMART AVE
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City | ELMONT
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State | NY
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Zip | 11003-1731
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Country | US
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Telephone | 516-354-5600
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Fax | 516-354-1480
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Provider Business Mailing Address
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Address Line | 135 ROCKMART AVE
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City | ELMONT
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State | NY
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Zip | 11003-1731
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Country | US
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Telephone | 516-354-5600
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TIFFANY PRIESTER
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Credential | NP
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Telephone | 516-354-5600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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