Provider Demographics
NPI:1649885666
Name:PELAIA, CAROLE JANE (LPN)
Entity type:Individual
Prefix:MISS
First Name:CAROLE
Middle Name:JANE
Last Name:PELAIA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 ROUNDTREE CT
Mailing Address - Street 2:
Mailing Address - City:BEACON
Mailing Address - State:NY
Mailing Address - Zip Code:12508-2117
Mailing Address - Country:US
Mailing Address - Phone:845-797-0258
Mailing Address - Fax:
Practice Address - Street 1:100 FORRESTAL HTS
Practice Address - Street 2:
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508-3733
Practice Address - Country:US
Practice Address - Phone:845-797-0258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2258133747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3747A0650XMedicaid