Provider Demographics
NPI:1811451131
Name:CARABALLO, MADELINE (RN)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:CARABALLO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 BERGEN AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455-4048
Mailing Address - Country:US
Mailing Address - Phone:718-401-5141
Mailing Address - Fax:718-401-5105
Practice Address - Street 1:500 BERGEN AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-4048
Practice Address - Country:US
Practice Address - Phone:718-401-5141
Practice Address - Fax:718-401-5105
Is Sole Proprietor?:No
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY500272163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY500272OtherRN LICENSE