MEDICARE: PROMIT ROY AGNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	F312370-01	NY

General Provider Information

NPI Number	:	1134096548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROMIT ROY AGNP

Provider Business Mailing Address
First Line	:	1494 MARSHALL ST
Second Line	:
City	:	ELMONT
State	:	NY
Zip	:	11003-1332
Country	:	US
Telephone Number	:	646-371-0689
Fax Number	:

Provider Business Practice Location Address
First Line	:	1494 MARSHALL ST
Second Line	:
City	:	ELMONT
State	:	NY
Zip	:	11003-1332
Country	:	US
Telephone Number	:	646-371-0689
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2025
Last Update Date	:	10/24/2025

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Directions to “ PROMIT ROY AGNP” Practice Location

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