Provider Demographics
NPI:1114258852
Name:NICDAO, LOUIGI P (P T)
Entity Type:Individual
Prefix:
First Name:LOUIGI
Middle Name:P
Last Name:NICDAO
Suffix:
Gender:F
Credentials:P T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 BROAD AVE
Mailing Address - Street 2:PAT. #3
Mailing Address - City:RIDGEFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07657-2385
Mailing Address - Country:US
Mailing Address - Phone:201-312-5986
Mailing Address - Fax:
Practice Address - Street 1:2604 3RD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454-1199
Practice Address - Country:US
Practice Address - Phone:347-590-3047
Practice Address - Fax:347-590-8089
Is Sole Proprietor?:No
Enumeration Date:2010-01-20
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031279225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist