Organization
CLNIVATORS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASMINE PIERCE (PRACTICE MANAGER)
(516) 244-9904
Entity
Organization
Contact information
Practice address
169 S MAIN ST UNIT 352, NEW CITY, NY 10956-3353
(844) 482-8677
(718) 763-1203
Mailing address
801 WYNGATE DR E, VALLEY STREAM, NY 11580-1404
(516) 244-9904
(718) 763-1203
Taxonomy
Speciality
Code
Description
License number
State
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
Primary
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
Other
Enumeration date
11/08/2019
Last updated
11/08/2019
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