Provider Demographics
NPI:1245843929
Name:ALICEA, NEFTALI
Entity type:Individual
Prefix:
First Name:NEFTALI
Middle Name:
Last Name:ALICEA
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 1:51 MONTGOMERY AVE
Mailing Address - Street 2:
Mailing Address - City:MASTIC
Mailing Address - State:NY
Mailing Address - Zip Code:11950-2610
Mailing Address - Country:US
Mailing Address - Phone:631-205-4172
Mailing Address - Fax:
Practice Address - Street 1:51 MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:MASTIC
Practice Address - State:NY
Practice Address - Zip Code:11950-2610
Practice Address - Country:US
Practice Address - Phone:631-205-4172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY299373-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse