Basic Information
| Provider Information | |||||||||
| NPI: | 1780938373 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EARL | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 185 OLD COUNTRY RD | ||||||||
| Address2: | STE 2 | ||||||||
| City: | RIVERHEAD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 119012121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312984479 | ||||||||
| FaxNumber: | 6315913047 | ||||||||
| Practice Location | |||||||||
| Address1: | 496 COUNTY RD 111 | ||||||||
| Address2: | BLDG B | ||||||||
| City: | MANORVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 119493341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314053200 | ||||||||
| FaxNumber: | 6313956010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2012 | ||||||||
| LastUpdateDate: | 02/26/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F337324-1 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.