MEDICARE: MODERN FAMILY HEALTH NP PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1346131257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MODERN FAMILY HEALTH NP PLLC

Provider Business Mailing Address
First Line	:	11 RALPH PL STE 209
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-4405
Country	:	US
Telephone Number	:	929-580-9757
Fax Number	:	646-349-2117

Provider Business Practice Location Address
First Line	:	11 RALPH PL STE 209
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-4405
Country	:	US
Telephone Number	:	929-580-9757
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	ELENA SAPON
Credential	:
Telephone Number	:	929-580-9757

Provider Enumeration Date	:	07/10/2025
Last Update Date	:	04/12/2026

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