Provider Demographics
NPI:1710242433
Name:WINE, SARITA (LPN)
Entity Type:Individual
Prefix:MS
First Name:SARITA
Middle Name:
Last Name:WINE
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 1:1809 3RD AVE
Mailing Address - Street 2:SUITE 10F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6101
Mailing Address - Country:US
Mailing Address - Phone:347-527-8803
Mailing Address - Fax:212-828-5649
Practice Address - Street 1:1809 3RD AVE
Practice Address - Street 2:SUITE 10F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6101
Practice Address - Country:US
Practice Address - Phone:347-527-8803
Practice Address - Fax:212-828-5649
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306703164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse