Provider Demographics
NPI:1639295637
Name:AMMON, HELENE E (RN)
Entity Type:Individual
Prefix:
First Name:HELENE
Middle Name:E
Last Name:AMMON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 PITT AVE
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-1807
Mailing Address - Country:US
Mailing Address - Phone:631-667-6532
Mailing Address - Fax:
Practice Address - Street 1:725 VETERANS MEMORIAL HIGHWAY - BUILDING C-928
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-6100
Practice Address - Country:US
Practice Address - Phone:631-853-8524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202765-1163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)