Provider Demographics
NPI:1306168380
Name:AUBOURG, VERLAINE
Entity type:Individual
Prefix:
First Name:VERLAINE
Middle Name:
Last Name:AUBOURG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VERLAINE
Other - Middle Name:
Other - Last Name:AUBOURG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:28 PAERDEGAT 8 TH STREET
Mailing Address - Street 2:1 ST FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4108
Mailing Address - Country:US
Mailing Address - Phone:917-889-1024
Mailing Address - Fax:917-889-1024
Practice Address - Street 1:1809 NOSTRAND AVENUE
Practice Address - Street 2:2 ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-7181
Practice Address - Country:US
Practice Address - Phone:718-421-4224
Practice Address - Fax:718-421-4774
Is Sole Proprietor?:No
Enumeration Date:2010-02-18
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY299949164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02386450Medicaid