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Organization

NURSING SERVICE PROVIDER

Active
Other names
nursing service provider
Organization subpart
No

Provider details

NPI number
Authorized official
MR. EMMANUEL PHILOGENE (LPN)
(631) 647-3048
Entity
Organization

Contact information

Practice address
916 SPUR DR S, BAY SHORE, NY 11706-4709
(631) 647-3048
Mailing address
916 SPUR DR S, BAY SHORE, NY 11706-4709
(631) 647-3048

Taxonomy

Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
312239-1
NY

Other

Enumeration date
12/12/2014
Last updated
12/12/2014
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