Healthcare Provider Details

I. General information

NPI: 1497557953
Provider Name (Legal Business Name): NICOLE RAPACCIOLI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2025
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BRADHURST AVE
HAWTHORNE NY
10532-2140
US

IV. Provider business mailing address

23 ROGERS DR
NEW ROCHELLE NY
10804-1012
US

V. Phone/Fax

Practice location:
  • Phone: 914-493-7000
  • Fax:
Mailing address:
  • Phone: 914-200-2627
  • Fax: 914-200-2627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number034405
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: