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Organization

PROACTIVE ADULT HEALTH NP, P.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. PETER DUPERVAL NURSE PRACTITIONER (OWNER)
(516) 915-9771
Entity
Organization

Contact information

Practice address
17 LINMOUTH RD, MALVERNE, NY 11565-2202
(516) 915-9771
Mailing address
PO BOX 292, MALVERNE, NY 11565-0292
(516) 915-9771

Taxonomy

Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary

Other

Enumeration date
11/11/2022
Last updated
11/11/2022
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