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NPI Code Detail

MEDICARE: PRIMARY CARE NP IN FAMILY HEALTH AND ADULT HEALTH OF NEW YORK PLLC

MEDICARE: PRIMARY CARE NP IN FAMILY HEALTH AND ADULT HEALTH OF NEW YORK PLLC
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
1261QP2300XPrimary Care Clinic/Center

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1A100000571OTHERNYMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1194975524
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRIMARY CARE NP IN FAMILY HEALTH AND ADULT HEALTH OF NEW YORK PLLC
Provider Business Mailing Address
First Line : 130 ROSE AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10306-2241
Country : US
Telephone Number : 718-980-1553
Fax Number :
Provider Business Practice Location Address
First Line : 130 ROSE AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10306-2241
Country : US
Telephone Number : 718-980-1553
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MRS. VIRGINIA NELSON
Credential : NP
Telephone Number : 718-980-1553
Provider Enumeration Date : 09/22/2008
Last Update Date : 02/02/2011

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