Provider Demographics
NPI:1689767204
Name:ISCHIA, BEVERLY GENE (FAMILY NURSE PRACTIT)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:GENE
Last Name:ISCHIA
Suffix:
Gender:F
Credentials:FAMILY NURSE PRACTIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 ROCKPORT RD.
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:37 MAIN ST.
Practice Address - Street 2:
Practice Address - City:WHITESBORO
Practice Address - State:NY
Practice Address - Zip Code:13492
Practice Address - Country:US
Practice Address - Phone:315-736-9337
Practice Address - Fax:315-624-5152
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF300407363L00000X
NY337598207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF300407Medicaid
NYF300407Medicaid