Provider Demographics
NPI:1366153199
Name:ON THE GO NP IN ADULT HEALTH
Entity type:Organization
Organization Name:ON THE GO NP IN ADULT HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/ CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, NP-C
Authorized Official - Phone:718-413-8168
Mailing Address - Street 1:442 S OYSTER BAY RD # 1020
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-3515
Mailing Address - Country:US
Mailing Address - Phone:718-413-8168
Mailing Address - Fax:
Practice Address - Street 1:130 S FORDHAM RD
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-6000
Practice Address - Country:US
Practice Address - Phone:516-522-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty