Provider Demographics
NPI:1437692860
Name:FRANCILOT, OTHNIEL
Entity Type:Individual
Prefix:
First Name:OTHNIEL
Middle Name:
Last Name:FRANCILOT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42A GLENMORE AVE
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-4131
Mailing Address - Country:US
Mailing Address - Phone:516-670-7588
Mailing Address - Fax:631-236-5820
Practice Address - Street 1:42A GLENMORE AVE
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-4131
Practice Address - Country:US
Practice Address - Phone:516-670-7588
Practice Address - Fax:631-236-5820
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-03
Last Update Date:2016-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10290539164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse