Provider Demographics
NPI:1659406106
Name:ARBOLINO, SALLY JANE (CPNP)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:JANE
Last Name:ARBOLINO
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:MS
Other - First Name:SALLY
Other - Middle Name:J
Other - Last Name:ARBOLINO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPNP
Mailing Address - Street 1:209 YORK ST
Mailing Address - Street 2:PS 307 ROOM#140
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-1509
Mailing Address - Country:US
Mailing Address - Phone:718-834-4294
Mailing Address - Fax:718-834-4295
Practice Address - Street 1:209 YORK ST
Practice Address - Street 2:PS 307 ROOM#140
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-1509
Practice Address - Country:US
Practice Address - Phone:718-834-4294
Practice Address - Fax:718-834-4295
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF380187363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1I 02091550 2Medicaid