Provider Demographics
NPI:1720659634
Name:NURSE PRACTITIONER IN ADULT GERONTOLOGY FAMILY AND PALLATIVE
Entity Type:Organization
Organization Name:NURSE PRACTITIONER IN ADULT GERONTOLOGY FAMILY AND PALLATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GABRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:917-915-2866
Mailing Address - Street 1:169 S MAIN STREET
Mailing Address - Street 2:SUITE 352
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956
Mailing Address - Country:US
Mailing Address - Phone:844-482-8677
Mailing Address - Fax:718-763-1203
Practice Address - Street 1:169 S MAIN STREET
Practice Address - Street 2:SUITE 352
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956
Practice Address - Country:US
Practice Address - Phone:844-482-8677
Practice Address - Fax:718-763-1203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care