Individual provider · NPI-1

Charles Bordes

Licensed Practical Nurse · Islandia, NY

NPI number1780989533
StatusActive
Last updated in NPPESJan 25, 2011

Details

NPI
1780989533
Entity type
Individual (NPI-1)
Name
Charles Bordes
Sex
Male
Sole proprietor
Yes
Enumeration date
Jan 25, 2011
Last updated
Jan 25, 2011

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
164W00000X Licensed Practical Nurse295085-1NYYes

Practice location

59 Dean Street
Islandia, NY 11749-1715

Phone 631-786-9418

Mailing address

59 Dean Street
Islandia, NY 11749-1715

Phone 631-786-9418 · Fax 631-630-6527

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