Provider Demographics
NPI:1972874691
Name:FOLEFOCK, LEKEAKA (LPN)
Entity Type:Individual
Prefix:
First Name:LEKEAKA
Middle Name:
Last Name:FOLEFOCK
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 1:3023 MOLLY PITCHER DR
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-6163
Mailing Address - Country:US
Mailing Address - Phone:917-573-2203
Mailing Address - Fax:
Practice Address - Street 1:3023 MOLLY PITCHER DR
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-6163
Practice Address - Country:US
Practice Address - Phone:917-573-2203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-26
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY731854163WP0809X, 164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Single Specialty