Provider Demographics
NPI:1841423340
Name:FLEURENTIN, JOE EDDY
Entity Type:Individual
Prefix:
First Name:JOE EDDY
Middle Name:
Last Name:FLEURENTIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 MEYER AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-3133
Mailing Address - Country:US
Mailing Address - Phone:516-825-0996
Mailing Address - Fax:516-825-0996
Practice Address - Street 1:241 MEYER AVE
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-3133
Practice Address - Country:US
Practice Address - Phone:516-825-0996
Practice Address - Fax:516-825-0996
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY248507164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse