=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649509274
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MONICA MARIA VOTRA NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2009
-----------------------------------------------------
Last Update Date | 12/10/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 E MAIN ST SOUTHSIDE HOSPITAL - DEPARTMENT OF CARDIOLOGY
-----------------------------------------------------
City | BAY SHORE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11706-8408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-968-3171
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 301 E MAIN ST
-----------------------------------------------------
City | BAY SHORE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11706-8408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-968-3171
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | F304360
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------