=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831067230
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EAST END NURSE PRACTITIONER IN FAMILY HEALTH PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2025
-----------------------------------------------------
Last Update Date | 02/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 160 MIDDLE RD STE 1
-----------------------------------------------------
City | SAYVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11782-3126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-239-8262
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 160 MIDDLE RD STE 1
-----------------------------------------------------
City | SAYVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11782-3126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-270-0014
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DOREEN SMITH
-----------------------------------------------------
Credential | FNP
-----------------------------------------------------
Telephone | 631-523-7826
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------