| Staley Psychiatric Nurse Practitioner Pllc | |
|
19605 Foothill Ave Hollis NY 11423-1413 | |
| (718) 470-2245 | |
| (718) 470-2245 |
| Full Name | Staley Psychiatric Nurse Practitioner Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 19605 Foothill Ave, Hollis, New York |
| Authorized Official Name and Position | Angela Douglas-staley (PRESIDENT) |
| Authorized Official Contact | 7184702245 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Staley Psychiatric Nurse Practitioner Pllc 19605 Foothill Ave Hollis NY 11423-1413 Ph: (718) 470-2245 | Staley Psychiatric Nurse Practitioner Pllc 19605 Foothill Ave Hollis NY 11423-1413 Ph: (718) 470-2245 |
| NPI Number | 1316581267 |
|---|---|
| Provider Enumeration Date | 11/04/2019 |
| Last Update Date | 11/04/2019 |
| Medicare PECOS PAC ID | 7911328075 |
|---|---|
| Medicare Enrollment ID | O20200528002557 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316581267 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Angela Douglas Staley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538469770 PECOS PAC ID: 4688806805 Enrollment ID: I20140422000958 |
| Provider Name | Bobby L Staley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649512112 PECOS PAC ID: 0648691634 Enrollment ID: I20200529000576 |
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