=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699216986
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL EASTMAN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2017
-----------------------------------------------------
Last Update Date | 09/29/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6938A THURSBY AVE
-----------------------------------------------------
City | ARVERNE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11692-1138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-234-1830
-----------------------------------------------------
Fax | 718-213-4606
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6938A THURSBY AVE
-----------------------------------------------------
City | ARVERNE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11692-1138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-234-1830
-----------------------------------------------------
Fax | 718-213-4606
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WI0500X
-----------------------------------------------------
Taxonomy Name | Infusion Therapy Registered Nurse
-----------------------------------------------------
License Number | 431855-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------