Provider Demographics
NPI:1982258869
Name:PRUSKI, CAROLINE (NP)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:PRUSKI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 ORCHARD ST APT 4B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-2712
Mailing Address - Country:US
Mailing Address - Phone:860-777-5673
Mailing Address - Fax:
Practice Address - Street 1:108 W 39TH ST RM 1601
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-8350
Practice Address - Country:US
Practice Address - Phone:646-559-4659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309325363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health