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General NPI Number Information
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NPI Number | 1386947778
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Entity Type | Organization
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Legal Business Name | GERICARE PLUS NP ADULT HEALTH & NP GERONTOLOGY HOUSE CALLS PLLC
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Dates
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Enumeration Date | 12/07/2010
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Last Update Date | 12/07/2010
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Provider Practice Location Address
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Address Line | 656 LENOX RD
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City | NORTH BALDWIN
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State | NY
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Zip | 11510-1019
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Country | US
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Telephone | 917-929-3388
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Fax |
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Provider Business Mailing Address
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Address Line | 656 LENOX RD
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City | NORTH BALDWIN
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State | NY
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Zip | 11510-1019
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Country | US
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Telephone | 917-929-3388
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTIONER IN ADULT HEALTH
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Name | GINA LUCIEN
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Credential | ANP-C
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Telephone | 917-929-3388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 340543
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 302642
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License Number State | NY
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