Healthcare Provider Details

I. General information

NPI: 1194717009
Provider Name (Legal Business Name): CAROL J COOPER-BAUCICOT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 WHITE PLAINS RD
BRONX NY
10473-2631
US

IV. Provider business mailing address

731 WHITE PLAINS RD
BRONX NY
10473-2631
US

V. Phone/Fax

Practice location:
  • Phone: 718-589-8324
  • Fax: 718-378-2880
Mailing address:
  • Phone: 718-589-8324
  • Fax: 718-378-2880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberF360035
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: