Basic Information
| Provider Information | |||||||||
| NPI: | 1760525505 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FIORE | ||||||||
| FirstName: | EDITH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CPNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 MINEOLA BLVD FL 2 | ||||||||
| Address2: | |||||||||
| City: | MINEOLA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115014089 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166633511 | ||||||||
| FaxNumber: | 5166633070 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 MINEOLA BLVD FL 2 | ||||||||
| Address2: | |||||||||
| City: | MINEOLA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115014089 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166633511 | ||||||||
| FaxNumber: | 5166633070 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2007 | ||||||||
| LastUpdateDate: | 03/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0200X | 22 539932 | NY | N | Nursing Service Providers | Registered Nurse | Pediatrics | 363LP0200X | 38 382169 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 02632713 | 05 | NY | MEDICAID |