Individual provider Active NPI

Alisa Gallucci, FNP

  • Family Nurse Practitioner
  • Staten Island, NY
National Provider Identifier
1750136719
Registry record updated Apr 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
F35363901 Issued in NY
Practice address
11 Ralph PL Ste 112
Staten Island, NY 10304-4408
Phone
(718) 954-2202
Fax
(718) 351-6848
NPI assigned
Apr 22, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X F35363901 NY Primary

Addresses

Primary practice location

11 Ralph PL Ste 112
Staten Island, NY 10304-4408

Mailing address

907 Center St
Union Beach, NJ 07735-2819
Phone (917) 783-2090

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
F35363901NYMDFamily Nurse Practitioner

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1713744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713744000000",
    "number": "1750136719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "907 CENTER ST",
            "city": "UNION BEACH",
            "state": "NJ",
            "postal_code": "077352819",
            "telephone_number": "917-783-2090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 RALPH PL STE 112",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103044408",
            "telephone_number": "718-954-2202",
            "fax_number": "718-351-6848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GALLUCCI",
        "first_name": "ALISA",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-22",
        "last_updated": "2024-04-22",
        "certification_date": "2024-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F35363901",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.