Provider Demographics
NPI:1083079446
Name:FAVARD, BERNADETTE
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:FAVARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 BEACH 114 STREET
Mailing Address - Street 2:PROMENADE NURSING HOME
Mailing Address - City:ROCKAWAY PARK,NY
Mailing Address - State:NY
Mailing Address - Zip Code:11694
Mailing Address - Country:US
Mailing Address - Phone:718-945-4600
Mailing Address - Fax:718-634-8327
Practice Address - Street 1:140 BEACH 114STREET
Practice Address - Street 2:PROMENADEN URSING HOME
Practice Address - City:ROCKAWAY PARK,
Practice Address - State:NY
Practice Address - Zip Code:11694
Practice Address - Country:US
Practice Address - Phone:646-353-3209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY324400164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse