Basic Information
Provider Information
NPI: 1851354161
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CAMELI
FirstName: DENISE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: F.N.P.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 69
Address2:  
City: HAWTHORNE
State: NY
PostalCode: 105320069
CountryCode: US
TelephoneNumber: 9144938375
FaxNumber: 9143471832
Practice Location
Address1: 19 BRADHURST AVE
Address2: SUITE 2100
City: HAWTHORNE
State: NY
PostalCode: 105322140
CountryCode: US
TelephoneNumber: 9144938375
FaxNumber: 9143471832
Other Information
ProviderEnumerationDate: 04/08/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XF333562NYY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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