Organization
NP ON THE GO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LILA SHAMS N.P. (NURSE PRACTITIONER)
(917) 864-3822
Entity
Organization
Contact information
Practice address
3444 KNIGHT ST, OCEANSIDE, NY 11572-4639
(917) 864-3822
(800) 557-3140
Mailing address
3444 KNIGHT ST, OCEANSIDE, NY 11572-4639
(917) 864-3822
(800) 557-3140
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
F307201
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A300137189
MEDICARE PTAN
NY
Enumeration date
03/02/2016
Last updated
03/02/2016
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