Provider Demographics
NPI:1376803643
Name:ISRAEL, PATRICIA
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:ISRAEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15002 88TH AVE
Mailing Address - Street 2:APT 5F
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-3740
Mailing Address - Country:US
Mailing Address - Phone:917-353-3460
Mailing Address - Fax:
Practice Address - Street 1:15002 88TH AVE
Practice Address - Street 2:APT 5F
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-3740
Practice Address - Country:US
Practice Address - Phone:917-353-3460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308605164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse