Healthcare Provider Details

I. General information

NPI: 1639842297
Provider Name (Legal Business Name): RACHEL PUCCIARELLI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 TOMPKINS AVE
STATEN ISLAND NY
10304-2601
US

IV. Provider business mailing address

91 TOMPKINS AVE
STATEN ISLAND NY
10304-2601
US

V. Phone/Fax

Practice location:
  • Phone: 718-876-1200
  • Fax: 718-876-0864
Mailing address:
  • Phone: 718-876-1200
  • Fax: 718-876-0864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number732329
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: