Organization
SP NURSE PRACTITIONER IN ADULT HEALTH PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SEDA ANGELINA PORT NP (OWNER)
(212) 961-6767
Entity
Organization
Contact information
Practice address
428 E HARRISON ST, LONG BEACH, NY 11561-2346
(212) 961-6767
Mailing address
428 E HARRISON ST, LONG BEACH, NY 11561-2346
(212) 961-6767
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
10/31/2022
Last updated
03/30/2023
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