Provider Demographics
NPI:1073859138
Name:LICENSED PRACTICAL NURSE
Entity Type:Organization
Organization Name:LICENSED PRACTICAL NURSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PRACTICAL NURSE
Authorized Official - Prefix:
Authorized Official - First Name:ANGELI
Authorized Official - Middle Name:ALEXSIS
Authorized Official - Last Name:DE LEON
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:917-434-1727
Mailing Address - Street 1:73 AVENUE C
Mailing Address - Street 2:APT 9
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-6845
Mailing Address - Country:US
Mailing Address - Phone:917-434-1727
Mailing Address - Fax:
Practice Address - Street 1:73 AVENUE C
Practice Address - Street 2:APT 9
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-6835
Practice Address - Country:US
Practice Address - Phone:917-434-1727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306669251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health