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NPI Code Detail

MEDICARE: DREW CARABALLO NP

MEDICARE:   DREW  CARABALLO  NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner405707NY

General Provider Information

NPI Number : 1194555763
Entity Type Code : Individual
Provider Name (Legal Business Name) : DREW CARABALLO NP
Provider Business Mailing Address
First Line : 93 ARLO RD APT 1A
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10301-3889
Country : US
Telephone Number : 718-304-3886
Fax Number :
Provider Business Practice Location Address
First Line : 93 ARLO RD APT 1A
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10301-3889
Country : US
Telephone Number : 718-304-3886
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2024
Last Update Date : 08/07/2024

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