MEDICARE: ALBERT CHAPUSETTE

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
1	164W00000X	Licensed Practical Nurse	318019	NY
2	390200000X	Student in an Organized Health Care Education/Training Program	318019-1	NY

General Provider Information

NPI Number	:	1720475627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALBERT CHAPUSETTE

Provider Business Mailing Address
First Line	:	2353 EAST 15TH STREET BROOKLYN NY 11229
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	11229
Country	:	US
Telephone Number	:	347-749-2015
Fax Number	:

Provider Business Practice Location Address
First Line	:	2353 E 15TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4318
Country	:	US
Telephone Number	:	347-749-2015
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2015
Last Update Date	:	04/01/2016

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