Provider Demographics
NPI:1245591155
Name:NATOLI, NICOLE (MA)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:NATOLI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 ONTARIO ST
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-5109
Mailing Address - Country:US
Mailing Address - Phone:631-879-8378
Mailing Address - Fax:
Practice Address - Street 1:459 ONTARIO ST
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-5109
Practice Address - Country:US
Practice Address - Phone:631-879-8378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist