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General NPI Number Information
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NPI Number | 1831802909
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Entity Type | Organization
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Legal Business Name | OPERATION ENGAGE INC
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Dates
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Enumeration Date | 01/03/2023
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Last Update Date | 01/03/2023
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Provider Practice Location Address
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Address Line | 163 CHARLES BLVD
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City | VALLEY COTTAGE
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State | NY
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Zip | 10989-2438
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Country | US
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Telephone | 631-624-2872
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Fax |
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Provider Business Mailing Address
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Address Line | 111 5TH ST
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City | HOLBROOK
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State | NY
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Zip | 11741-3701
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BOARD MEMBER
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Name | RYAN BAUM
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Credential |
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Telephone | 516-729-8606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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