Individual
CHARLOTTE YVROSE LASONTANT BASSARAGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1477 HYLAN BLVD, STATEN ISLAND, NY 10305-1906
(718) 979-6900
Mailing address
378 SAINT MARKS PL, STATEN ISLAND, NY 10301-2409
(718) 448-5903
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
269027
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
269027
NYS LICENSE
NY
Enumeration date
11/05/2009
Last updated
11/05/2009
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