MEDICARE: PATRICIA EPPOLITO FNP

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	363LF0000X	Family Nurse Practitioner	F331503	NY

General Provider Information

NPI Number	:	1942315270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA EPPOLITO FNP

Provider Business Mailing Address
First Line	:	425 GUY PARK AVE
Second Line	:	SUITE 100
City	:	AMSTERDAM
State	:	NY
Zip	:	12010-1043
Country	:	US
Telephone Number	:	518-843-4393
Fax Number	:	518-842-1618

Provider Business Practice Location Address
First Line	:	425 GUY PARK AVE
Second Line	:	SUITE 100
City	:	AMSTERDAM
State	:	NY
Zip	:	12010-1043
Country	:	US
Telephone Number	:	518-843-4393
Fax Number	:	518-842-1618

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

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	07/08/2007

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