Provider Demographics
NPI:1073700076
Name:NANUET MEDICAL PROFESSIONALS, LLC
Entity Type:Organization
Organization Name:NANUET MEDICAL PROFESSIONALS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:INGRASSIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-623-2456
Mailing Address - Street 1:36 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-3093
Mailing Address - Country:US
Mailing Address - Phone:845-623-2456
Mailing Address - Fax:845-623-6420
Practice Address - Street 1:36 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-3093
Practice Address - Country:US
Practice Address - Phone:845-623-2456
Practice Address - Fax:845-623-6420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY128583207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00410206Medicaid
NYB13439Medicare UPIN