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General NPI Number Information
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NPI Number | 1477875508
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Entity Type | Organization
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Legal Business Name | SWEET P
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Dates
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Enumeration Date | 02/16/2010
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Last Update Date | 02/16/2010
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Provider Practice Location Address
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Address Line | 16937 144TH RD
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City | JAMAICA
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State | NY
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Zip | 11434-5929
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Country | US
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Telephone | 171-897-8722
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Fax | 718-978-7003
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Provider Business Mailing Address
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Address Line | 751 E 83RD ST 2ND FLOOR
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City | BROOKLYN
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State | NY
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Zip | 11236-3541
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Country | US
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Telephone | 347-455-7205
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Fax |
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Authorized Official
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Title or Position | NURSE
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Name | MRS. MARGARETTE CHARLES PROPHILE
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Credential | LPN
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Telephone | 347-455-7205
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 285101-1
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License Number State | NY
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