1740335660 NPI number — MS. VENITA ALEXANDRA DAMON LPN

Table of content: MS. VENITA ALEXANDRA DAMON LPN (NPI 1740335660)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740335660 NPI number — MS. VENITA ALEXANDRA DAMON LPN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAMON
Provider First Name:
VENITA
Provider Middle Name:
ALEXANDRA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STEWART
Provider Other First Name:
VENITA
Provider Other Middle Name:
ALEXANDRA
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1740335660
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12038 231ST STREET
Provider Second Line Business Mailing Address:
CAMBRIA HEIGHTS JAMAICA
Provider Business Mailing Address City Name:
QUEENS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11411-2220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-527-9315
Provider Business Mailing Address Fax Number:
718-527-9315

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12038 231ST STREET
Provider Second Line Business Practice Location Address:
CAMBRIA HEIGHTS JAMAICA
Provider Business Practice Location Address City Name:
QUEENS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11411-2220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-527-9315
Provider Business Practice Location Address Fax Number:
718-527-9315
Provider Enumeration Date:
01/23/2007

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: 164W00000X , with the licence number:  2438311 , 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)

  • Identifier: 01690239 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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