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Organization

NASH LIFESTYLE LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
NICOLE SAMPLE-HARRIS MD (OWNER)
(516) 667-0737
Entity
Organization

Contact information

Practice address
1937 GRAND AVENUE, BALDWIN, NY 11510-2837
(516) 667-0737
Mailing address
1937 GRAND AVENUE, BALDWIN, NY 11510-2837
(516) 667-0737

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary

Other

Enumeration date
01/10/2022
Last updated
01/10/2022
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