Provider Demographics
NPI:1295360725
Name:SEA WAVE NP ADULT HEALTH PC
Entity Type:Organization
Organization Name:SEA WAVE NP ADULT HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-693-5790
Mailing Address - Street 1:1164 E 45TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-1430
Mailing Address - Country:US
Mailing Address - Phone:347-693-5790
Mailing Address - Fax:
Practice Address - Street 1:10 E 39TH ST RM 914
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0111
Practice Address - Country:US
Practice Address - Phone:347-389-2008
Practice Address - Fax:877-632-5925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty