Healthcare Provider Details

I. General information

NPI: 1730542341
Provider Name (Legal Business Name): NICOLLETTE CAPUTO N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 BROOME ST FL 2
NEW YORK NY
10013-3569
US

IV. Provider business mailing address

440 BROOME ST FL 2
NEW YORK NY
10013-3569
US

V. Phone/Fax

Practice location:
  • Phone: 468-231-6116
  • Fax: 646-871-6820
Mailing address:
  • Phone: 646-823-1611
  • Fax: 646-871-6820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number340480
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number340480
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: