Healthcare Provider Details

I. General information

NPI: 1669953733
Provider Name (Legal Business Name): RITA CARPENTIERI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 08/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 OAKDALE MNR
SUFFERN NY
10901-5708
US

IV. Provider business mailing address

5 OAKDALE MNR
SUFFERN NY
10901-5708
US

V. Phone/Fax

Practice location:
  • Phone: 718-828-2666
  • Fax:
Mailing address:
  • Phone: 718-828-2666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number756074
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: