Provider Demographics
NPI:1699290288
Name:ARGELIA NURSE PRACTITIONER IN ADULT HEALTH PC
Entity type:Organization
Organization Name:ARGELIA NURSE PRACTITIONER IN ADULT HEALTH PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADULT NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ARGELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:631-278-3452
Mailing Address - Street 1:96 HURON DR
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-3718
Mailing Address - Country:US
Mailing Address - Phone:631-278-3452
Mailing Address - Fax:
Practice Address - Street 1:200 HOWELLS RD
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-5351
Practice Address - Country:US
Practice Address - Phone:631-278-3452
Practice Address - Fax:631-278-3452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-04
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY003750083003OtherUNITED HEALTHCARE
NY17803991OtherAETNA
NYF306138-A85OtherHEALTHFIRST
NY03784847Medicaid