Provider Demographics
NPI:1922295096
Name:CARLUCCI, PAMELA (RN)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:
Last Name:CARLUCCI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:CARLUCCI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:189 WHEATLEY RD
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11545
Mailing Address - Country:US
Mailing Address - Phone:516-626-1000
Mailing Address - Fax:516-626-2039
Practice Address - Street 1:189 WHEATLEY RD
Practice Address - Street 2:
Practice Address - City:GLEN HEAD
Practice Address - State:NY
Practice Address - Zip Code:11545-2641
Practice Address - Country:US
Practice Address - Phone:516-626-1000
Practice Address - Fax:516-626-2039
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4150331163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY111720254Other111720254