Active NPI
Kristen Fuccillo
- Family Nurse Practitioner
- New York, NY
National Provider Identifier
1679298905
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 350520
- Practice address
- 525 E 68TH St
New York, NY 10065-4870 - Phone
- (212) 749-5166
- NPI assigned
- Oct 10, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Lactation Consultant (Registered Nurse) | 163WL0100X | L318845 | NY | |
| Family Nurse Practitioner | 363LF0000X | 350520 | NY | Primary |
Addresses
Primary practice location
525 E 68TH St
New York, NY 10065-4870
Mailing address
50 E 28TH St Apt 14L
New York, NY 10016-7976
Phone (516) 749-1241
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241007000778 | NY | Order and Referring Only - Nurse Practitioner | 1557892171 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L318845 | NY | MD | Lactation Consultant (Registered Nurse) |
| 350520 | NY | MD | Family Nurse Practitioner |
Interoperability endpoints
- krc9026@direct.nyp.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1665360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1756425600000",
"number": "1679298905",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "50 E 28TH ST APT 14L",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100167976",
"telephone_number": "516-749-1241"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "525 E 68TH ST",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100654870",
"telephone_number": "212-749-5166"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FUCCILLO",
"first_name": "KRISTEN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-10-10",
"last_updated": "2025-08-29",
"certification_date": "2025-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "163WL0100X",
"taxonomy_group": "",
"desc": "Registered Nurse, Lactation Consultant",
"state": "NY",
"license": "L318845",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "NY",
"license": "350520",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.