Provider Demographics
NPI:1548397763
Name:LONDON, DARRIN GREG (NP)
Entity Type:Individual
Prefix:MR
First Name:DARRIN
Middle Name:GREG
Last Name:LONDON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 JACKSON CRES
Mailing Address - Street 2:
Mailing Address - City:CENTERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11721-1056
Mailing Address - Country:US
Mailing Address - Phone:631-385-8402
Mailing Address - Fax:
Practice Address - Street 1:70 PINELAWN RD
Practice Address - Street 2:HOSPICE INN
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3106
Practice Address - Country:US
Practice Address - Phone:631-773-6706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301895363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS79755Medicare UPIN