Provider Demographics
NPI:1053749143
Name:LABAZE, ALIN
Entity type:Individual
Prefix:
First Name:ALIN
Middle Name:
Last Name:LABAZE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 OMNI PARC DR
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-5948
Mailing Address - Country:US
Mailing Address - Phone:845-405-3757
Mailing Address - Fax:
Practice Address - Street 1:54 OMNI PARC DR
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-5948
Practice Address - Country:US
Practice Address - Phone:845-405-3757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-28
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY315005164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse