Basic Information
| Provider Information | |||||||||
| NPI: | 1194755025 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HIGGINS | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | S. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 69 SOUTH BROADWAY,GERIATRIC SERVICES,P.C. | ||||||||
| Address2: | |||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107014004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9143765555 | ||||||||
| FaxNumber: | 9143760285 | ||||||||
| Practice Location | |||||||||
| Address1: | 1205 TROY SCHENECTADY RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | LATHAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121101074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5183483176 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2006 | ||||||||
| LastUpdateDate: | 07/20/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F332005 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 02174596 | 05 | NY | MEDICAID |