Basic Information
Provider Information
NPI: 1053676965
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CARDAMONA
FirstName: MARGARET
MiddleName: MARY
NamePrefix: MRS.
NameSuffix:  
Credential: FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 155 CRYSTAL RUN RD
Address2:  
City: MIDDLETOWN
State: NY
PostalCode: 109414028
CountryCode: US
TelephoneNumber: 8457036999
FaxNumber: 8457036297
Practice Location
Address1: 2 MEDICAL PARK DR
Address2: SUITE 5
City: WEST NYACK
State: NY
PostalCode: 109941965
CountryCode: US
TelephoneNumber: 8457036999
FaxNumber: 8457036297
Other Information
ProviderEnumerationDate: 07/06/2012
LastUpdateDate: 02/06/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XF337202-1NYY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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