=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780453084
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KERLINE LAHENS-HEADLEY NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/27/2023
-----------------------------------------------------
Last Update Date | 03/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5141 BROADWAY
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10034-1159
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-932-4000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 355
-----------------------------------------------------
City | POMONA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10970-0355
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-602-8581
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | F311808
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------