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General NPI Number Information
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NPI Number | 1528727757
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Entity Type | Organization
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Legal Business Name | ALTIMATE NP HEALTHCARE SERVICES LLC
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Dates
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Enumeration Date | 12/15/2021
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Last Update Date | 04/17/2023
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Provider Practice Location Address
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Address Line | 547 NORTH AVE
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City | NEW ROCHELLE
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State | NY
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Zip | 10801-2601
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Country | US
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Telephone | 917-488-7910
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Fax |
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Provider Business Mailing Address
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Address Line | 3403 ROPES AVE
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City | BRONX
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State | NY
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Zip | 10475-1016
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Country | US
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Telephone | 917-488-7910
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SANDRA BOATENG-WILSON
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Credential | FNP
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Telephone | 917-488-7910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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