Provider Demographics
NPI:1356634711
Name:CELESTIN, WILLY (LPN)
Entity Type:Individual
Prefix:MR
First Name:WILLY
Middle Name:
Last Name:CELESTIN
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 1:755 E 85TH ST
Mailing Address - Street 2:PH
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3503
Mailing Address - Country:US
Mailing Address - Phone:347-299-2262
Mailing Address - Fax:
Practice Address - Street 1:755 E 85TH ST
Practice Address - Street 2:PH
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3503
Practice Address - Country:US
Practice Address - Phone:347-299-2262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY288016-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse