Provider Demographics
NPI:1467216150
Name:PAUL ADULT HEALTH NURSE PRACTITIONER PLLC
Entity Type:Organization
Organization Name:PAUL ADULT HEALTH NURSE PRACTITIONER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSHINI
Authorized Official - Middle Name:MYLAKKATTU
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-459-9500
Mailing Address - Street 1:7 WEAVER LN
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5018
Mailing Address - Country:US
Mailing Address - Phone:631-459-9500
Mailing Address - Fax:
Practice Address - Street 1:7 WEAVER LN
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-5018
Practice Address - Country:US
Practice Address - Phone:631-459-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty