Healthcare Provider Details

I. General information

NPI: 1083365845
Provider Name (Legal Business Name): CAROLINE NATALIE KARDASZEWSKI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2022
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 HYLAN BLVD
STATEN ISLAND NY
10305-1922
US

IV. Provider business mailing address

152 BADEN PL
STATEN ISLAND NY
10306-6054
US

V. Phone/Fax

Practice location:
  • Phone: 718-667-3577
  • Fax: 718-667-3043
Mailing address:
  • Phone: 646-200-1188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number349102
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: