# ADULT GERIATRIC HEALTH NP PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962137646
- **Authorized official:** NATALIA MAXIMOVSKY NP (OWNER)
- **Authorized official phone:** (347) 377-1979

## Contact information

- **Practice address:** 11 RALPH PL STE 112, STATEN ISLAND, NY 10304-4408
- **Practice address phone:** (347) 377-1979
- **Mailing address:** 11 RALPH PL STE 112, STATEN ISLAND, NY 10304-4408

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LA2200X | Adult Health Nurse Practitioner | — | NULL | Yes |
| 363LA2200X | Adult Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 07/18/2022
- **Last updated:** 07/18/2022