Provider Demographics
NPI:1942315270
Name:EPPOLITO, PATRICIA (FNP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:EPPOLITO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 GUY PARK AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-1043
Mailing Address - Country:US
Mailing Address - Phone:518-843-4393
Mailing Address - Fax:518-842-1618
Practice Address - Street 1:425 GUY PARK AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-1043
Practice Address - Country:US
Practice Address - Phone:518-843-4393
Practice Address - Fax:518-842-1618
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331503363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS45342Medicare UPIN