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General NPI Number Information
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NPI Number | 1689390312
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Entity Type | Individual
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Provider Name | LYALYA LOGUSH NP
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Gender | Female
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Dates
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Enumeration Date | 10/14/2022
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 700 COLUMBUS AVE APT 7H
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City | NEW YORK
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State | NY
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Zip | 10025-6623
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Country | US
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Telephone | 646-295-2542
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Fax |
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Provider Business Mailing Address
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Address Line | 55 WATER ST FL 2
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City | NEW YORK
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State | NY
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Zip | 10041-0010
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Country | US
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Telephone | 646-680-2888
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Fax | 516-542-5556
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F350496
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License Number State | NY
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