Provider Demographics
NPI:1669672655
Name:BEHAN, LAURENCE FRANCIS (RN)
Entity Type:Individual
Prefix:MR
First Name:LAURENCE
Middle Name:FRANCIS
Last Name:BEHAN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MECHANICVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12118-1726
Mailing Address - Country:US
Mailing Address - Phone:518-664-6541
Mailing Address - Fax:
Practice Address - Street 1:95 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MECHANICVILLE
Practice Address - State:NY
Practice Address - Zip Code:12118-1726
Practice Address - Country:US
Practice Address - Phone:518-664-6541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY348779-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01231387Medicaid