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Organization
SP NURSE PRACTITIONER IN ADULT HEALTH PC
Active
Organization
SP NURSE PRACTITIONER IN ADULT HEALTH PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SEDA ANGELINA PORT NP (OWNER)
(212) 961-6767
Entity
Organization
Contact information
Practice address
428 E HARRISON ST, LONG BEACH, NY 11561-2346
(212) 961-6767
Mailing address
428 E HARRISON ST, LONG BEACH, NY 11561-2346
(212) 961-6767
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
—
NULL
363LA2200X
Adult Health Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
10/31/2022
Last updated
03/30/2023
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