Provider Demographics
NPI:1598448979
Name:BISHOP, CAROL GRACE (RN)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:GRACE
Last Name:BISHOP
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:GRACE
Other - Last Name:ANTONOWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:180 ADAMS ST E
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-1624
Mailing Address - Country:US
Mailing Address - Phone:631-219-0947
Mailing Address - Fax:
Practice Address - Street 1:180 ADAMS ST E
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-1624
Practice Address - Country:US
Practice Address - Phone:631-219-0947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY348646163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice