Basic Information
Provider Information
NPI: 1396941548
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CRAPELLA
FirstName: LISE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 20 GRAND STREET, 3RD FL
Address2:  
City: WARWICK
State: NY
PostalCode: 109901035
CountryCode: US
TelephoneNumber: 8453685951
FaxNumber: 8459875979
Practice Location
Address1: 255 LAFAYETTE AVE
Address2:  
City: SUFFERN
State: NY
PostalCode: 109014812
CountryCode: US
TelephoneNumber: 8453685000
FaxNumber: 8453685169
Other Information
ProviderEnumerationDate: 06/25/2007
LastUpdateDate: 02/02/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163WW0000XF303096-1NYY Nursing Service ProvidersRegistered NurseWound Care

No ID Information.


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