Provider Demographics
NPI:1093835787
Name:PFOST, BRENDA JOYCE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:JOYCE
Last Name:PFOST
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:BRENDA
Other - Middle Name:JOYCE
Other - Last Name:TANNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:9 STORZ PL
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-4326
Mailing Address - Country:US
Mailing Address - Phone:631-888-2988
Mailing Address - Fax:
Practice Address - Street 1:9 STORZ PL
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-4326
Practice Address - Country:US
Practice Address - Phone:631-888-2988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120783-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01300352Medicaid