Individual
MR. PENDOR HAIYEDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
7901 BROADWAY # D1-05, ELMHURST, NY 11373-1329
(718) 334-2488
(718) 334-5006
Mailing address
7901 BROADWAY # D1-05, ELMHURST, NY 11373-1329
(718) 334-2488
(718) 334-5006
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
F309258
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
F405602
NY
Other
Enumeration date
09/10/2019
Last updated
03/06/2024
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