Healthcare Provider Details

I. General information

NPI: 1366996407
Provider Name (Legal Business Name): RACHEL LISE CIOTA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2016
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4610 CENTER BLVD APT 2111
LONG ISLAND CITY NY
11109-5882
US

IV. Provider business mailing address

4610 CENTER BLVD APT 2111
LONG ISLAND CITY NY
11109-5882
US

V. Phone/Fax

Practice location:
  • Phone: 631-456-1130
  • Fax:
Mailing address:
  • Phone: 631-456-1130
  • Fax: 718-684-5266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number345263
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: