Provider Demographics
NPI:1679579114
Name:CARACIOLO, MONICA (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:
Last Name:CARACIOLO
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MISS
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSPT
Mailing Address - Street 1:2237 WANTAGH AVE
Mailing Address - Street 2:UNIT A
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-3945
Mailing Address - Country:US
Mailing Address - Phone:516-735-3783
Mailing Address - Fax:
Practice Address - Street 1:2237A WANTAGH AVE
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-3917
Practice Address - Country:US
Practice Address - Phone:516-826-0116
Practice Address - Fax:516-826-0115
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-21
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020726-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000000077425OtherGHI HMO
NY1995673OtherUNITED HEALTHCARE
NY6698715OtherGHI
NY00000094481OtherBETTER HEALTH ADVANTAGE
NY143405OtherVYTRA
NY823529OtherMPN
NY9544000OtherCIGNA PPO
NYP00031175OtherMCR RR
NY3C3953OtherHEALTHNET
NYQP1091OtherBC/BS
NY20726OtherHIP
NY1737291OtherFIRST HEALTH
NY17401OtherCIGNA ORTHONET, POS
NY9918OtherACCESS
NYP2778675OtherOXFORD
NY00000094481OtherBETTER HEALTH ADVANTAGE