Healthcare Provider Details

I. General information

NPI: 1457094179
Provider Name (Legal Business Name): ACHSAH KURIAN CHEMPOLA FNP; RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2022
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 BLEAKLEY DRIVE
PEEKSKILL NY
10566
US

IV. Provider business mailing address

26 BLEAKLEY DRIVE
PEEKSKILL NY
10566
US

V. Phone/Fax

Practice location:
  • Phone: 646-761-3991
  • Fax:
Mailing address:
  • Phone: 646-761-3991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF345724
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: