Healthcare Provider Details

I. General information

NPI: 1801603030
Provider Name (Legal Business Name): CAROLYN REPPUCCI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2024
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 WATER ST
WHITE PLAINS NY
10601-1401
US

IV. Provider business mailing address

12 WATER ST
WHITE PLAINS NY
10601-1401
US

V. Phone/Fax

Practice location:
  • Phone: 508-789-3839
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number894913
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: