Provider Demographics
NPI:1063871523
Name:PERSONAL CARE NP ADULT HEALTH PRACTICE PLLC
Entity type:Organization
Organization Name:PERSONAL CARE NP ADULT HEALTH PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTIONER
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:EDOUARD
Authorized Official - Suffix:
Authorized Official - Credentials:ANP
Authorized Official - Phone:718-217-7111
Mailing Address - Street 1:19105 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-2527
Mailing Address - Country:US
Mailing Address - Phone:718-217-7111
Mailing Address - Fax:718-217-7113
Practice Address - Street 1:19105 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-2527
Practice Address - Country:US
Practice Address - Phone:718-217-7111
Practice Address - Fax:718-217-7113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-12
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3053411261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care