Individual
MS. AIDA CARMEN LICATA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
33 N WASHINGTON AVE, CENTEREACH, NY 11720-2132
(631) 880-0416
Mailing address
33 N. WASHINGTON AVE, CENTEREACH, NY 11720-2132
(631) 880-0416
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
266529-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1558550798
—
NY
Enumeration date
01/08/2009
Last updated
01/08/2009
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