=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841619558
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRIDGET LUCILLE COCCARO MSN, FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2014
-----------------------------------------------------
Last Update Date | 11/12/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1838 COMMERCE ST
-----------------------------------------------------
City | YORKTOWN HEIGHTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10598-4400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-962-3500
-----------------------------------------------------
Fax | 914-245-7875
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 60 GOLDENS BRIDGE RD
-----------------------------------------------------
City | KATONAH
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10536-3447
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-232-1919
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WC0200X
-----------------------------------------------------
Taxonomy Name | Critical Care Medicine Registered Nurse
-----------------------------------------------------
License Number | 527175
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 338636
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------