Healthcare Provider Details

I. General information

NPI: 1851703037
Provider Name (Legal Business Name): CAROLE HARTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2014
Last Update Date: 05/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 BARD AVE
STATEN ISLAND NY
10310-1664
US

IV. Provider business mailing address

86 WENLOCK ST
STATEN ISLAND NY
10303-2635
US

V. Phone/Fax

Practice location:
  • Phone: 718-818-1094
  • Fax:
Mailing address:
  • Phone: 646-642-8062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF338673-
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF338673-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: