Provider Demographics
NPI:1831481860
Name:MERCY & GRACE NURSE PRACTITIONER IN GERONTOLOGY OF NEW YORK PLLC
Entity Type:Organization
Organization Name:MERCY & GRACE NURSE PRACTITIONER IN GERONTOLOGY OF NEW YORK PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TITILOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADELOKIKI
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:718-448-0442
Mailing Address - Street 1:89 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-1601
Mailing Address - Country:US
Mailing Address - Phone:718-448-0442
Mailing Address - Fax:347-466-5393
Practice Address - Street 1:89 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-1601
Practice Address - Country:US
Practice Address - Phone:718-448-0442
Practice Address - Fax:347-466-5393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-10
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty