Healthcare Provider Details

I. General information

NPI: 1346706801
Provider Name (Legal Business Name): RACHEL LUCENTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2019
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

682 FOREST AVE
STATEN ISLAND NY
10310-2507
US

IV. Provider business mailing address

2177 VICTORY BLVD
STATEN ISLAND NY
10314-6603
US

V. Phone/Fax

Practice location:
  • Phone: 718-370-3730
  • Fax: 718-698-9412
Mailing address:
  • Phone: 718-370-3730
  • Fax: 718-698-9412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number309081
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number309081
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number309081
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: