=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831253186
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT HENDERSON MCALPIN LPN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8045 WINCHESTER BLVD
-----------------------------------------------------
City | QUEENS VILLAGE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11427-2193
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-479-8395
-----------------------------------------------------
Fax | 718-465-1947
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 50 NOSTRAND AVE
-----------------------------------------------------
City | BRENTWOOD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11717-3708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-357-3588
-----------------------------------------------------
Fax | 631-357-3588
-----------------------------------------------------
=====================================================
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 | 258352
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------