1790804599 NPI number — CAROL PUCEK, N. P., P.C.

Table of content: (NPI 1790804599)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790804599 NPI number — CAROL PUCEK, N. P., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROL PUCEK, N. P., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790804599
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 HEMLOCK HOLLOW RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOPEWELL JUNCTION
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12533-7402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-227-6884
Provider Business Mailing Address Fax Number:
845-227-6884

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
510 HAIGHT AVE STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POUGHKEEPSIE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12603-2464
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-485-3506
Provider Business Practice Location Address Fax Number:
845-485-8780
Provider Enumeration Date:
03/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PUCEK
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
NURSE PRACTITIONER
Authorized Official Telephone Number:
845-227-6884

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  266501 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 363L00000X , with the licence number: F400301 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 137118N . This is a "VALUEOPTIONS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1033150 . This is a "BEACON HEALTH STRATEGIES" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2053176 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7322339 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 911903 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7795261 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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