Individual provider Active NPI

Candice Elise Carlucci Haddock, NP

  • Family Nurse Practitioner
  • Bronx, NY
National Provider Identifier
1821715491
Registry record updated Oct 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
349252 Issued in NY
Practice address
1250 Waters PL
Bronx, NY 10461-2720
Phone
(718) 920-4800
NPI assigned
Oct 25, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical-Surgical Registered Nurse 163WM0705X 718830 NY
Family Nurse Practitioner 363LF0000X 349252 NY Primary

Addresses

Primary practice location

1250 Waters PL
Bronx, NY 10461-2720

Mailing address

945 Knollwood Rd
White Plains, NY 10603-1121

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240311000697 NY Practitioner - Nurse Practitioner 8921444191 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

122 Maple Ave
FL 9
White Plains, NY 10601-4706
Phone (914) 948-1000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
718830NYMDMedical-Surgical Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Montefiore Medical Center CurrentSince Jan 13, 2024 Accepting new patients
Montefiore Medical Center CurrentSince Jan 13, 2024 Accepting new patients
White Plains Physician Services PC CurrentSince Apr 30, 2024 Accepting new patients
Montefiore Mount Vernon Hospital Past Accepting new patients

Locations

111 E 210th St
Bronx, NY 10467

1250 Waters Pl
Bronx, NY 10461
Phone (718) 409-9444

185 Kisco Ave
Ste 300
Mount Kisco, NY 10549
Phone (914) 242-2020

122 Maple Ave
Fl 9
White Plains, NY 10601
Phone (914) 849-3755

100 Corporate Dr
Ste 100
Yonkers, NY 10701
Phone (914) 378-6148

Networks

  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1666656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666656000000",
    "number": "1821715491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "945 KNOLLWOOD RD",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106031121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 WATERS PL",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104612720",
            "telephone_number": "718-920-4800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLUCCI HADDOCK",
        "first_name": "CANDICE",
        "middle_name": "ELISE",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-25",
        "last_updated": "2022-10-25",
        "certification_date": "2022-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WM0705X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Medical-Surgical",
            "state": "NY",
            "license": "718830",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "349252",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.