Provider Demographics
NPI:1194047845
Name:CAMEAU, MARIO J (LPN)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:J
Last Name:CAMEAU
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-1456
Mailing Address - Country:US
Mailing Address - Phone:917-498-0041
Mailing Address - Fax:
Practice Address - Street 1:252 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-1456
Practice Address - Country:US
Practice Address - Phone:917-498-0041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10291490164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse