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General NPI Number Information
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NPI Number | 1881311900
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Entity Type | Organization
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Legal Business Name | WEST LAWRENCE NP FAMILY HEALTH PLLC
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Dates
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Enumeration Date | 10/20/2022
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Last Update Date | 10/20/2022
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Provider Practice Location Address
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Address Line | 509 JARVIS AVE
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691-5442
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Country | US
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Telephone | 917-509-6962
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Fax | 718-471-7247
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Provider Business Mailing Address
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Address Line | 509 JARVIS AVE
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691-5442
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Country | US
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Telephone | 917-509-6962
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Fax | 718-471-7247
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Authorized Official
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Title or Position | OWNER
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Name | MRS. BRENDA SPORN
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Credential | NP
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Telephone | 917-509-6962
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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