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General NPI Number Information
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NPI Number | 1396452462
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Entity Type | Individual
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Provider Name | STEPHANIE SOBERANIS PIKUL NP
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Gender | Female
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Dates
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Enumeration Date | 10/28/2022
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Last Update Date | 11/14/2022
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Provider Practice Location Address
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Address Line | 560 NORTHERN BLVD
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City | GREAT NECK
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State | NY
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Zip | 11021-5118
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Country | US
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Telephone | 516-487-6200
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Fax |
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Provider Business Mailing Address
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Address Line | 115 7TH AVE
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City | HOLTSVILLE
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State | NY
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Zip | 11742-2386
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Country | US
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Telephone | 347-218-0116
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 350595
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License Number State | NY
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