Provider Demographics
NPI:1194168393
Name:SPEID, LANDY J (LPN)
Entity type:Individual
Prefix:
First Name:LANDY
Middle Name:J
Last Name:SPEID
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 RUTGERS CT
Mailing Address - Street 2:APT 2D
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-2576
Mailing Address - Country:US
Mailing Address - Phone:347-331-7372
Mailing Address - Fax:
Practice Address - Street 1:23218 MERRICK BLVD
Practice Address - Street 2:
Practice Address - City:LAURELTON
Practice Address - State:NY
Practice Address - Zip Code:11413-2115
Practice Address - Country:US
Practice Address - Phone:718-528-3432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY283254164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse