Provider Demographics
NPI:1790804599
Name:CAROL PUCEK, N. P., P.C.
Entity Type:Organization
Organization Name:CAROL PUCEK, N. P., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:L
Authorized Official - Last Name:PUCEK
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:845-227-6884
Mailing Address - Street 1:4 HEMLOCK HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533-7402
Mailing Address - Country:US
Mailing Address - Phone:845-227-6884
Mailing Address - Fax:845-227-6884
Practice Address - Street 1:510 HAIGHT AVE STE 102
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-2464
Practice Address - Country:US
Practice Address - Phone:845-485-3506
Practice Address - Fax:845-485-8780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY266501163W00000X
NYF400301363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY137118NOtherVALUEOPTIONS
NY1033150OtherBEACON HEALTH STRATEGIES
NY2053176OtherCIGNA
NY7322339OtherAETNA
NY911903OtherMVP
NY7795261OtherAETNA
NYP00010Medicare UPIN
NY911903OtherMVP