Provider Demographics
NPI:1346794427
Name:FABELLA, NEIL D (LPN)
Entity Type:Individual
Prefix:MR
First Name:NEIL
Middle Name:D
Last Name:FABELLA
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 FORT LEE PL
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:NY
Mailing Address - Zip Code:10962-2707
Mailing Address - Country:US
Mailing Address - Phone:845-359-5674
Mailing Address - Fax:
Practice Address - Street 1:213 FORT LEE PL
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:NY
Practice Address - Zip Code:10962-2707
Practice Address - Country:US
Practice Address - Phone:845-359-5674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-07
Last Update Date:2016-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302653164W00000X
NJ26NP06509200164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse