Provider Demographics
NPI:1144513813
Name:STAY HEALTHY, NP IN ADULT HEALTH PC
Entity type:Organization
Organization Name:STAY HEALTHY, NP IN ADULT HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEONID
Authorized Official - Middle Name:
Authorized Official - Last Name:KOL
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:718-850-6345
Mailing Address - Street 1:13876 QUEENS BLVD
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-2930
Mailing Address - Country:US
Mailing Address - Phone:718-850-6345
Mailing Address - Fax:718-559-4896
Practice Address - Street 1:13876 QUEENS BLVD
Practice Address - Street 2:1ST FLOOR
Practice Address - City:BRIARWOOD
Practice Address - State:NY
Practice Address - Zip Code:11435-2930
Practice Address - Country:US
Practice Address - Phone:718-850-6345
Practice Address - Fax:718-559-4896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF304465363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty