Provider Demographics
NPI:1013295906
Name:LONG ISLAND ADULT HEALTH NP, PLLC
Entity Type:Organization
Organization Name:LONG ISLAND ADULT HEALTH NP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEARD
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C EDD
Authorized Official - Phone:631-278-3805
Mailing Address - Street 1:16 PINE HILL LN
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-6526
Mailing Address - Country:US
Mailing Address - Phone:631-278-3805
Mailing Address - Fax:631-254-0721
Practice Address - Street 1:16 PINE HILL LN
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-6526
Practice Address - Country:US
Practice Address - Phone:631-278-3805
Practice Address - Fax:631-254-0721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-27
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
F304135-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty