Provider Demographics
NPI:1669626214
Name:PILE, REBECCA OMATAYA (LPN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:OMATAYA
Last Name:PILE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191-49 115TH AVE
Mailing Address - Street 2:SAINT ALBANS
Mailing Address - City:QUEENS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-2727
Mailing Address - Country:US
Mailing Address - Phone:718-776-7519
Mailing Address - Fax:
Practice Address - Street 1:19149 115TH AVE
Practice Address - Street 2:SAINT ALBANS
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-2727
Practice Address - Country:US
Practice Address - Phone:718-776-7519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2715651-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse