Provider Demographics
NPI:1578341145
Name:BEHRBOM, IOLANI (NP)
Entity Type:Individual
Prefix:
First Name:IOLANI
Middle Name:
Last Name:BEHRBOM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:IOLANI
Other - Middle Name:
Other - Last Name:DALY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:31 PINE ST
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-2026
Mailing Address - Country:US
Mailing Address - Phone:631-827-9673
Mailing Address - Fax:
Practice Address - Street 1:800 COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3822
Practice Address - Country:US
Practice Address - Phone:516-403-9104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310829363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health