Individual
MAURICIO VERGARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
67 CHESTNUT ST, LYNBROOK, NY 11563-1838
(917) 612-4401
Mailing address
67 CHESTNUT ST, LYNBROOK, NY 11563-1838
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
311550
NY
363LG0600X
Gerontology Nurse Practitioner
311550
NY
Other
Enumeration date
12/08/2023
Last updated
12/08/2023
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