Provider Demographics
NPI:1952638058
Name:CHELSEA PEDIATRICS NURSE PRACTITIONER PLLC
Entity Type:Organization
Organization Name:CHELSEA PEDIATRICS NURSE PRACTITIONER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:LATERRA-FERRARO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:845-360-5373
Mailing Address - Street 1:40 MATTHEWS ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-1964
Mailing Address - Country:US
Mailing Address - Phone:845-360-5373
Mailing Address - Fax:845-360-5669
Practice Address - Street 1:40 MATTHEWS ST
Practice Address - Street 2:SUITE 201
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-1964
Practice Address - Country:US
Practice Address - Phone:845-360-5373
Practice Address - Fax:845-360-5669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-10
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY361310261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care