Healthcare Provider Details

I. General information

NPI: 1720475627
Provider Name (Legal Business Name): ALBERT CHAPUSETTE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2015
Last Update Date: 04/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2353 E 15TH ST
BROOKLYN NY
11229-4318
US

IV. Provider business mailing address

2353 EAST 15TH STREET BROOKLYN NY 11229
NEW YORK NY
11229
US

V. Phone/Fax

Practice location:
  • Phone: 347-749-2015
  • Fax:
Mailing address:
  • Phone: 347-749-2015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number318019-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number318019
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: