Provider Demographics
NPI:1013387471
Name:BARTOLOMEO, MARIOLINA
Entity Type:Individual
Prefix:
First Name:MARIOLINA
Middle Name:
Last Name:BARTOLOMEO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 YORK AVE APT 15P
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4857
Mailing Address - Country:US
Mailing Address - Phone:203-448-8153
Mailing Address - Fax:
Practice Address - Street 1:1320 YORK AVE APT 15P
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4857
Practice Address - Country:US
Practice Address - Phone:203-448-8153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307362363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health