Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 655291-1 | NY |
N | 363LP2300X | Nurse Practitioner - Primary Care | 655291-1 | NY |
NPI | 1023467321 |
---|---|
Provider Name | Carlo Pepia |
First Address | Staten Island, NY 10314-6222 |
Second Address | New York, NY 10016-6402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2016 |
Last Update Date | 07/06/2016 |