Healthcare Provider Details

I. General information

NPI: 1922169895
Provider Name (Legal Business Name): CARMEL HIPPIAS CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 10/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 68TH ST BAKER 23
NEW YORK NY
10065-4870
US

IV. Provider business mailing address

24040 70TH AVE # 17C
DOUGLASTON NY
11362-1948
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-3326
  • Fax:
Mailing address:
  • Phone: 718-229-3728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF381429
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: