Provider Demographics
NPI:1750337218
Name:BATRA, CAROL DAWN (FNP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:DAWN
Last Name:BATRA
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 1:107 PROSPECT STREET
Mailing Address - Street 2:
Mailing Address - City:ATTICA
Mailing Address - State:NY
Mailing Address - Zip Code:14011-1149
Mailing Address - Country:US
Mailing Address - Phone:585-591-6000
Mailing Address - Fax:585-591-6962
Practice Address - Street 1:107 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:ATTICA
Practice Address - State:NY
Practice Address - Zip Code:14011-1149
Practice Address - Country:US
Practice Address - Phone:585-591-6000
Practice Address - Fax:585-591-6962
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3323861363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA1777Medicare ID - Type Unspecified
NYQ15865Medicare UPIN