Provider Demographics
NPI:1164867982
Name:JANET LATTAN
Entity Type:Organization
Organization Name:JANET LATTAN
Other - Org Name:NONE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNERSHIP
Authorized Official - Prefix:MISS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:F
Authorized Official - Last Name:LATTAN
Authorized Official - Suffix:I
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:845-412-5413
Mailing Address - Street 1:17 HIGHLAND AVE
Mailing Address - Street 2:OTISVILLE
Mailing Address - City:OTISVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10963-2346
Mailing Address - Country:US
Mailing Address - Phone:845-412-5413
Mailing Address - Fax:845-412-6035
Practice Address - Street 1:17 HIGHLAND AVE
Practice Address - Street 2:OTISVILLE
Practice Address - City:OTISVILLE
Practice Address - State:NY
Practice Address - Zip Code:10963-2346
Practice Address - Country:US
Practice Address - Phone:845-412-5413
Practice Address - Fax:845-412-6035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY533277-1282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital