Healthcare Provider Details

I. General information

NPI: 1922573930
Provider Name (Legal Business Name): ELISSA M KAPPEL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2018
Last Update Date: 03/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 RONALD REAGAN BLVD
WARWICK NY
10990-4104
US

IV. Provider business mailing address

10 RONALD REAGAN BLVD
WARWICK NY
10990-4104
US

V. Phone/Fax

Practice location:
  • Phone: 845-986-2058
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number343416
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: