Provider Demographics
NPI:1952771545
Name:GLORYLAND NURSE PRACTITIONER IN FAMILY HEALTH P.C.
Entity Type:Organization
Organization Name:GLORYLAND NURSE PRACTITIONER IN FAMILY HEALTH P.C.
Other - Org Name:GLORLYLAND NURSE PRACTITIONERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:AFOLABI
Authorized Official - Middle Name:
Authorized Official - Last Name:POROYE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:347-469-9341
Mailing Address - Street 1:6226 BURCHELL RD
Mailing Address - Street 2:
Mailing Address - City:ARVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11692-1343
Mailing Address - Country:US
Mailing Address - Phone:347-469-9341
Mailing Address - Fax:718-559-6466
Practice Address - Street 1:6226 BURCHELL RD
Practice Address - Street 2:
Practice Address - City:ARVERNE
Practice Address - State:NY
Practice Address - Zip Code:11692-1343
Practice Address - Country:US
Practice Address - Phone:347-469-9341
Practice Address - Fax:718-559-6466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-25
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF336516363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty