Provider Demographics
NPI:1306179767
Name:ISRAEL, NAOMI (LPN)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:ISRAEL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 900093
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11690-0093
Mailing Address - Country:US
Mailing Address - Phone:718-759-8594
Mailing Address - Fax:
Practice Address - Street 1:16 POPLAR PL
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-1459
Practice Address - Country:US
Practice Address - Phone:718-759-8594
Practice Address - Fax:718-327-1518
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220538164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY220538OtherOFFICE OF PROFESSIONS - LPN LICENSE