MEDICARE: HALSEY FAMILY HEALTH NURSE PRACTITIONER SERVICES OF NY PC

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	261QP2300X	Primary Care Clinic/Center	333879	NY

General Provider Information

NPI Number	:	1851727317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HALSEY FAMILY HEALTH NURSE PRACTITIONER SERVICES OF NY PC

Provider Business Mailing Address
First Line	:	13423 229TH ST
Second Line	:
City	:	LAURELTON
State	:	NY
Zip	:	11413-2516
Country	:	US
Telephone Number	:	718-527-1991
Fax Number	:	718-602-6087

Provider Business Practice Location Address
First Line	:	1086 BROADWAY
Second Line	:	SUITE 4-5
City	:	BROOKLYN
State	:	NY
Zip	:	11221-3376
Country	:	US
Telephone Number	:	718-602-2086
Fax Number	:	718-602-2087

Authorized Official
Title or Position	:	FNP
Name	:	MRS. KERAN SEVENISE HILL
Credential	:	DHA
Telephone Number	:	718-527-1991

Provider Enumeration Date	:	09/16/2013
Last Update Date	:	09/18/2013

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