Healthcare Provider Details

I. General information

NPI: 1528620895
Provider Name (Legal Business Name): AIDA VIROLA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2019
Last Update Date: 07/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 BRETT RD
CARMEL NY
10512-3821
US

IV. Provider business mailing address

56 BRETT RD
CARMEL NY
10512-3821
US

V. Phone/Fax

Practice location:
  • Phone: 845-276-5079
  • Fax:
Mailing address:
  • Phone: 845-276-5079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number679246-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: