Provider Demographics
NPI:1386947778
Name:GERICARE PLUS NP ADULT HEALTH & NP GERONTOLOGY HOUSE CALLS PLLC
Entity type:Organization
Organization Name:GERICARE PLUS NP ADULT HEALTH & NP GERONTOLOGY HOUSE CALLS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTIONER IN ADULT HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCIEN
Authorized Official - Suffix:
Authorized Official - Credentials:ANP-C
Authorized Official - Phone:917-929-3388
Mailing Address - Street 1:656 LENOX RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-1019
Mailing Address - Country:US
Mailing Address - Phone:917-929-3388
Mailing Address - Fax:
Practice Address - Street 1:656 LENOX RD
Practice Address - Street 2:
Practice Address - City:NORTH BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-1019
Practice Address - Country:US
Practice Address - Phone:917-929-3388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302642363LA2200X
NY340543363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty