Provider Demographics
NPI:1821411638
Name:ULUSOY, MATTIE (LPN)
Entity Type:Individual
Prefix:
First Name:MATTIE
Middle Name:
Last Name:ULUSOY
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 1:28 FIFE DR
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-4010
Mailing Address - Country:US
Mailing Address - Phone:631-384-6852
Mailing Address - Fax:
Practice Address - Street 1:7 SEAFIELD LN
Practice Address - Street 2:
Practice Address - City:WESTHAMPTON BEACH
Practice Address - State:NY
Practice Address - Zip Code:11978-2714
Practice Address - Country:US
Practice Address - Phone:631-288-1122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3150881164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse