Provider Demographics
NPI:1578815197
Name:LINDA A. LAROCCO, FAMILY NURSE PRACTITIONER, PLLC
Entity Type:Organization
Organization Name:LINDA A. LAROCCO, FAMILY NURSE PRACTITIONER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAROCCO
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:845-744-4499
Mailing Address - Street 1:59 BONIFACE DR
Mailing Address - Street 2:PO BOX 1579
Mailing Address - City:PINE BUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12566-7011
Mailing Address - Country:US
Mailing Address - Phone:845-744-4499
Mailing Address - Fax:
Practice Address - Street 1:59 BONIFACE DR
Practice Address - Street 2:
Practice Address - City:PINE BUSH
Practice Address - State:NY
Practice Address - Zip Code:12566-7011
Practice Address - Country:US
Practice Address - Phone:845-744-4499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337273363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02391335Medicaid
NYA300000438Medicare PIN