Provider Demographics
NPI:1063541787
Name:BHOORASINGH, MERLENE MAE (NP)
Entity type:Individual
Prefix:MRS
First Name:MERLENE
Middle Name:MAE
Last Name:BHOORASINGH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 VALLEY STREET
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREET
Mailing Address - State:NY
Mailing Address - Zip Code:11580
Mailing Address - Country:US
Mailing Address - Phone:718-480-4026
Mailing Address - Fax:
Practice Address - Street 1:19 VALLEY STREET
Practice Address - Street 2:
Practice Address - City:VALLEY STREET
Practice Address - State:NY
Practice Address - Zip Code:11580
Practice Address - Country:US
Practice Address - Phone:718-480-4026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY483326363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MB1434810OtherDEA