Provider Demographics
NPI:1023297041
Name:LEMAISTRE, COLETTE
Entity type:Individual
Prefix:MRS
First Name:COLETTE
Middle Name:
Last Name:LEMAISTRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 COVERT AVE
Mailing Address - Street 2:APT. K1
Mailing Address - City:STEWART MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:11530-4909
Mailing Address - Country:US
Mailing Address - Phone:516-705-5865
Mailing Address - Fax:
Practice Address - Street 1:2856 FRANKEL BLVD
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-5432
Practice Address - Country:US
Practice Address - Phone:516-992-2570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194903-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDU54420DMedicaid