| Organization Name: | LONG ISLAND ADULT HEALTH NP, PLLC |
| NPI Number: | 1013295906 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KENYA BEARD (OWNER/PRESIDENT) |
| Mailing Address: | 16 Pine Hill Ln Dix Hills |
| State: | NY US |
| Postal Code: | 117466526 |
| Phone Number: | 6312783805 |
| Fax Number: | 6312540721 |
| NPI Enumeration Date: | 07/27/2011 |
| NPI Last Update Date: | 09/23/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | F304135-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |