Provider Demographics
NPI:1659599454
Name:CEBALLOS, CLARE (NP)
Entity Type:Individual
Prefix:
First Name:CLARE
Middle Name:
Last Name:CEBALLOS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 GUSTAVE L LEVY PL
Mailing Address - Street 2:MOUNT SINAI HOSPITAL, BOX 1656
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6500
Mailing Address - Country:US
Mailing Address - Phone:212-241-5415
Mailing Address - Fax:212-876-1729
Practice Address - Street 1:1 GUSTAVE L LEVY PL
Practice Address - Street 2:MOUNT SINAI HOSPITAL, BOX 1656
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6500
Practice Address - Country:US
Practice Address - Phone:212-241-5415
Practice Address - Fax:212-876-1729
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2013-03-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY380844363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02127782Medicaid
NY02127782Medicaid
NYP27169Medicare UPIN