Provider Demographics
NPI:1699314179
Name:SILVERLIFE NP IN ADULT HEALTH P.C.
Entity type:Organization
Organization Name:SILVERLIFE NP IN ADULT HEALTH P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:917-566-7645
Mailing Address - Street 1:3618 171ST ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-2209
Mailing Address - Country:US
Mailing Address - Phone:917-566-7645
Mailing Address - Fax:
Practice Address - Street 1:5836 254TH ST
Practice Address - Street 2:
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11362-2124
Practice Address - Country:US
Practice Address - Phone:917-566-7645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-31
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health