Provider Demographics
NPI:1811207962
Name:CARAGIULO, MARIE NICOLE (R-PA)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:NICOLE
Last Name:CARAGIULO
Suffix:
Gender:F
Credentials:R-PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 LOVELACE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-3208
Mailing Address - Country:US
Mailing Address - Phone:718-948-6099
Mailing Address - Fax:
Practice Address - Street 1:176 LOVELACE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-3208
Practice Address - Country:US
Practice Address - Phone:718-948-6099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006598363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical