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General NPI Number Information
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NPI Number | 1568958700
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Entity Type | Organization
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Legal Business Name | NURSE PRACTITIONER INFANT AND CHILD HEALTHCARE, PC
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Dates
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Enumeration Date | 07/10/2018
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Last Update Date | 07/10/2018
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Provider Practice Location Address
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Address Line | 1227 MAIN STREET SUITE 201
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City | PORT JEFFERSON
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State | NY
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Zip | 11777
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Country | US
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Telephone | 631-235-2401
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Fax | 631-689-3993
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Provider Business Mailing Address
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Address Line | PO BOX 631
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City | MILLER PLACE
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State | NY
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Zip | 11764
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Country | US
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Telephone | 631-235-2401
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Fax | 631-689-3993
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. MICHELE A. TRIOLO
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Credential | LPNP, NPP
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Telephone | 631-235-2401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 380749
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | F-400866-1
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License Number State | NY
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