MEDICARE: CAROL A CELONA FNP

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	163WG0000X	General Practice Registered Nurse	F334176	NY

General Provider Information

NPI Number	:	1619915386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL A CELONA FNP

Provider Business Mailing Address
First Line	:	622 W 114TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-7973
Country	:	US
Telephone Number	:	212-864-8084
Fax Number	:

Provider Business Practice Location Address
First Line	:	3160 21ST ST
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11106-4520
Country	:	US
Telephone Number	:	718-267-4265
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	07/08/2007

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