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General NPI Number Information
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NPI Number | 1124130802
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Entity Type | Individual
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Provider Name | JILL E COCCARO-SANTOS FNP
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 12/10/2014
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Provider Practice Location Address
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Address Line | 1978 CROMPOND ROAD MOUNT KISCO MEDICAL GROUP PC
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City | CORTLANDT MANOR
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State | NY
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Zip | 10567
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Country | US
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Telephone | 914-739-2121
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Fax | 914-739-2185
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Provider Business Mailing Address
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Address Line | 3333 HENRY HUDSON PKWY APARTMENT 20R
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City | BRONX
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State | NY
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Zip | 10463-3224
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Country | US
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Telephone | 646-306-5544
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Fax | 347-947-4579
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 030070
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F338865-1
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License Number State | NY
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