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General NPI Number Information
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NPI Number | 1447509880
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Entity Type | Organization
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Legal Business Name | EXECU-SEARCH
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Dates
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Enumeration Date | 08/30/2012
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Last Update Date | 08/30/2012
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Provider Practice Location Address
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Address Line | 2238 E 1ST ST
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City | BROOKLYN
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State | NY
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Zip | 11223-5144
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Country | US
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Telephone | 917-593-9820
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Fax |
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Provider Business Mailing Address
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Address Line | 2238 E 1ST ST
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City | BROOKLYN
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State | NY
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Zip | 11223-5144
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Country | US
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Telephone | 917-593-9820
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Fax |
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Authorized Official
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Title or Position | REGISTERED NURSE
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Name | MS. MARLENA SALOMON
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Credential | RN
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Telephone | 917-593-9820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | 641401
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License Number State | NY
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