Provider Demographics
NPI:1952628174
Name:CIARDULLI, ELAINA MARIE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ELAINA
Middle Name:MARIE
Last Name:CIARDULLI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:ELAINA
Other - Middle Name:MARIE
Other - Last Name:RUDOLPH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:178 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:TOWNSHIP OF WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07676-5212
Mailing Address - Country:US
Mailing Address - Phone:845-242-7128
Mailing Address - Fax:
Practice Address - Street 1:41 E POST RD
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-4607
Practice Address - Country:US
Practice Address - Phone:914-681-2560
Practice Address - Fax:914-681-2590
Is Sole Proprietor?:No
Enumeration Date:2010-04-27
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00302200363LF0000X
NYF336079-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily