Provider Demographics
NPI:1235330051
Name:AMIN, NICOLE MICHELLE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:MICHELLE
Last Name:AMIN
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-4212
Mailing Address - Country:US
Mailing Address - Phone:631-277-9283
Mailing Address - Fax:631-277-9394
Practice Address - Street 1:174 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2633
Practice Address - Country:US
Practice Address - Phone:631-277-9283
Practice Address - Fax:631-277-9394
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018070225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQG96810Medicare ID - Type UnspecifiedPHYSICAL THERAPY