=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538896618
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SQUARE HEALTH SERVICES NP IN PSYCHIATRY, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2022
-----------------------------------------------------
Last Update Date | 08/08/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7514 37TH AVE
-----------------------------------------------------
City | JACKSON HEIGHTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11372-6538
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-433-9333
-----------------------------------------------------
Fax | 718-433-9445
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7514 37TH AVE
-----------------------------------------------------
City | JACKSON HEIGHTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11372-6538
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-433-9333
-----------------------------------------------------
Fax | 718-433-9445
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PRACTITIONER
-----------------------------------------------------
Name | FERDOUSI BEGUM
-----------------------------------------------------
Credential | NURSE PRACTITIONER
-----------------------------------------------------
Telephone | 718-433-9333
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------