Individual
EDLIRA FOTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
15806 NORTHERN BLVD, FLUSHING, NY 11358-1641
(718) 445-3700
Mailing address
PO BOX 54677, LOS ANGELES, CA 90054-0677
(718) 445-3700
(718) 460-4051
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
F341248-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
881256669
DRIVER LICENSE
NY
Enumeration date
05/09/2018
Last updated
06/16/2018
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