Healthcare Provider Details

I. General information

NPI: 1174071260
Provider Name (Legal Business Name): PATRICK STRACUZZI FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2016
Last Update Date: 09/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

396 BROADWAY
KINGSTON NY
12401-4626
US

IV. Provider business mailing address

396 BROADWAY
KINGSTON NY
12401-4626
US

V. Phone/Fax

Practice location:
  • Phone: 845-331-3131
  • Fax:
Mailing address:
  • Phone: 845-331-3131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number341070
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: