1679579114 NPI number — MRS. MONICA CARACIOLO MSPT

Table of content: MRS. MONICA CARACIOLO MSPT (NPI 1679579114)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679579114 NPI number — MRS. MONICA CARACIOLO MSPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARACIOLO
Provider First Name:
MONICA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WALSH
Provider Other First Name:
MONICA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSPT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1679579114
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2237 WANTAGH AVE
Provider Second Line Business Mailing Address:
UNIT A
Provider Business Mailing Address City Name:
WANTAGH
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11793-3945
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-735-3783
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2237A WANTAGH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WANTAGH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11793-3917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-826-0116
Provider Business Practice Location Address Fax Number:
516-826-0115
Provider Enumeration Date:
06/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  020726-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000077425 . This is a "GHI HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1995673 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6698715 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00000094481 . This is a "BETTER HEALTH ADVANTAGE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 143405 . This is a "VYTRA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 823529 . This is a "MPN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 9544000 . This is a "CIGNA PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P00031175 . This is a "MCR RR" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3C3953 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: QP1091 . This is a "BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 20726 . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1737291 . This is a "FIRST HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 17401 . This is a "CIGNA ORTHONET, POS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 9918 . This is a "ACCESS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P2778675 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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