MEDICARE: CAROLINE PRUSKI 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
1	363LA2200X	Adult Health Nurse Practitioner	309325	NY

General Provider Information

NPI Number	:	1982258869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE PRUSKI NP

Provider Business Mailing Address
First Line	:	152 ORCHARD ST APT 4B
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10002-2712
Country	:	US
Telephone Number	:	860-777-5673
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 W 39TH ST RM 1601
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10018-8350
Country	:	US
Telephone Number	:	646-559-4659
Fax Number	:

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

Provider Enumeration Date	:	07/29/2019
Last Update Date	:	07/29/2019

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