=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770588378
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DENISE A ALBANO ANPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2005
-----------------------------------------------------
Last Update Date | 03/11/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 235 N BELLE MEAD RD
-----------------------------------------------------
City | EAST SETAUKET
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11733-3456
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-751-3000
-----------------------------------------------------
Fax | 631-751-3366
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 235 N BELLE MEAD RD
-----------------------------------------------------
City | EAST SETAUKET
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11733-3456
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-751-3000
-----------------------------------------------------
Fax | 631-751-3366
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | F302538
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | 9600447
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------