1689982340 NPI number — MS. GUIRLENE M DUBE RN

Table of content: MS. GUIRLENE M DUBE RN (NPI 1689982340)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689982340 NPI number — MS. GUIRLENE M DUBE RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUBE
Provider First Name:
GUIRLENE
Provider Middle Name:
M
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DUBE
Provider Other First Name:
GUIRLENE
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1689982340
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
761 GLOVER PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALDWIN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11510-3506
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-808-2936
Provider Business Mailing Address Fax Number:
516-960-9345

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
211 BROADWAY STE 301
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYNBROOK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11563-3290
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-717-1444
Provider Business Practice Location Address Fax Number:
516-960-9345
Provider Enumeration Date:
09/15/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  500521-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)