=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780038448
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PIERRE PERCY
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2016
-----------------------------------------------------
Last Update Date | 04/19/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 PENNSYLVANIA AVE
-----------------------------------------------------
City | HEMPSTEAD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11550-3433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-522-2543
-----------------------------------------------------
Fax | 516-481-4860
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 PENNSYLVANIA AVE
-----------------------------------------------------
City | HEMPSTEAD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11550-3433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-522-2543
-----------------------------------------------------
Fax | 516-481-4860
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | 324809-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------