Provider Demographics
NPI:1164638268
Name:NICOLOSI, ANTONINO (ETC)
Entity Type:Individual
Prefix:MR
First Name:ANTONINO
Middle Name:
Last Name:NICOLOSI
Suffix:
Gender:M
Credentials:ETC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3337 FRANCIS LEWIS BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-1928
Mailing Address - Country:US
Mailing Address - Phone:718-358-7505
Mailing Address - Fax:718-359-7587
Practice Address - Street 1:3337 FRANCIS LEWIS BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-1928
Practice Address - Country:US
Practice Address - Phone:718-357-7505
Practice Address - Fax:718-359-7587
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC003776156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician