Provider Demographics
NPI:1053331777
Name:MULLINS, NANCY (MS, PT)
Entity Type:Individual
Prefix:MISS
First Name:NANCY
Middle Name:
Last Name:MULLINS
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 MERRICK AVE
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-4748
Mailing Address - Country:US
Mailing Address - Phone:516-393-8900
Mailing Address - Fax:516-393-8969
Practice Address - Street 1:801 MERRICK AVE
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-4748
Practice Address - Country:US
Practice Address - Phone:516-393-8900
Practice Address - Fax:516-393-8969
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024502-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQS9611Medicare ID - Type UnspecifiedMEDICARE