Provider Demographics
NPI:1124130802
Name:COCCARO-SANTOS, JILL E (FNP)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:E
Last Name:COCCARO-SANTOS
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Gender:F
Credentials:FNP
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Mailing Address - Street 1:3333 HENRY HUDSON PKWY
Mailing Address - Street 2:APARTMENT 20R
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-3224
Mailing Address - Country:US
Mailing Address - Phone:646-306-5544
Mailing Address - Fax:347-947-4579
Practice Address - Street 1:1978 CROMPOND ROAD
Practice Address - Street 2:MOUNT KISCO MEDICAL GROUP PC
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567
Practice Address - Country:US
Practice Address - Phone:914-739-2121
Practice Address - Fax:914-739-2185
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-12-10
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Provider Licenses
StateLicense IDTaxonomies
NY030070225100000X
NYF338865-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI007057745Medicare PIN