Provider Demographics
NPI:1497044408
Name:ARISTIDE, BEAUVAL
Entity Type:Individual
Prefix:
First Name:BEAUVAL
Middle Name:
Last Name:ARISTIDE
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 1:1357 KIEFER AVE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-3232
Mailing Address - Country:US
Mailing Address - Phone:347-417-3681
Mailing Address - Fax:
Practice Address - Street 1:5 MIMOSA ST
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-3038
Practice Address - Country:US
Practice Address - Phone:347-413-9976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-30
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY632195163W00000X
NYF402521-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse