Provider Demographics
NPI:1073048583
Name:WEIDEN, NICOLE FRANCESCA
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:FRANCESCA
Last Name:WEIDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:FRANCESCA
Other - Last Name:DELUCA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:60 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545-1532
Mailing Address - Country:US
Mailing Address - Phone:516-633-7442
Mailing Address - Fax:
Practice Address - Street 1:60 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:GLEN HEAD
Practice Address - State:NY
Practice Address - Zip Code:11545-1532
Practice Address - Country:US
Practice Address - Phone:516-633-7442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-23
Last Update Date:2017-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist