MEDICARE: CARISSA PELZEL 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	346556	NY
2	363LF0000X	Family Nurse Practitioner	CNP4919	MN

General Provider Information

NPI Number	:	1942743471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARISSA PELZEL FNP

Provider Business Mailing Address
First Line	:	1825 JOHN F KENNEDY BLVD
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07305-2106
Country	:	US
Telephone Number	:	201-395-7600
Fax Number	:

Provider Business Practice Location Address
First Line	:	1825 JOHN F KENNEDY BLVD
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07305-2106
Country	:	US
Telephone Number	:	201-395-7600
Fax Number	:

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

Provider Enumeration Date	:	12/01/2016
Last Update Date	:	12/08/2025

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