Organization Name: | LAINE NP ADULT WELLNESS CARE PC |
NPI Number: | 1225450364 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ROSAIRE B LAINE (CEO) |
Mailing Address: | 539 De Mott Ave North Baldwin |
State: | NY US |
Postal Code: | 115101321 |
Phone Number: | 5162236088 |
Fax Number: | |
NPI Enumeration Date: | 01/08/2014 |
NPI Last Update Date: | 01/08/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QC1500X |
License Number: | F304165-1 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NY |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Community Health |
Taxonomy Definition: |