Healthcare Provider Details

I. General information

NPI: 1013149723
Provider Name (Legal Business Name): CAROLINE CARNEVALE FNP, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2009
Last Update Date: 09/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W 168TH ST VC4 - 432
NEW YORK NY
10032-3720
US

IV. Provider business mailing address

622 W 168TH ST VC4 - 432
NEW YORK NY
10032-3720
US

V. Phone/Fax

Practice location:
  • Phone: 646-319-4676
  • Fax: 212-305-7400
Mailing address:
  • Phone: 646-319-4676
  • Fax: 212-305-7400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF335816-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: