Provider Demographics
NPI:1558575332
Name:LAMOTHE, GERDA (NP)
Entity Type:Individual
Prefix:MRS
First Name:GERDA
Middle Name:
Last Name:LAMOTHE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 ESSEX RD
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-2022
Mailing Address - Country:US
Mailing Address - Phone:516-652-4383
Mailing Address - Fax:516-358-1256
Practice Address - Street 1:20002 LINDEN BLVD
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-3263
Practice Address - Country:US
Practice Address - Phone:718-276-9500
Practice Address - Fax:718-276-6462
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2021-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302869363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health