Provider Demographics
NPI:1861546582
Name:FORBUSH-GHARBI, DOREEN (LPN)
Entity type:Individual
Prefix:MS
First Name:DOREEN
Middle Name:
Last Name:FORBUSH-GHARBI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 436
Mailing Address - Street 2:
Mailing Address - City:MASTIC
Mailing Address - State:NY
Mailing Address - Zip Code:11950-0436
Mailing Address - Country:US
Mailing Address - Phone:631-648-7754
Mailing Address - Fax:
Practice Address - Street 1:2816 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-5222
Practice Address - Country:US
Practice Address - Phone:631-648-7754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY275188-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse