Provider Demographics
NPI:1245592914
Name:MARCIANO, NICOLE (ED)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:MARCIANO
Suffix:
Gender:F
Credentials:ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2042 FOXGLOVE CIR
Mailing Address - Street 2:
Mailing Address - City:BELLPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11713-3077
Mailing Address - Country:US
Mailing Address - Phone:631-767-5386
Mailing Address - Fax:
Practice Address - Street 1:2042 FOXGLOVE CIR
Practice Address - Street 2:
Practice Address - City:BELLPORT
Practice Address - State:NY
Practice Address - Zip Code:11713-3077
Practice Address - Country:US
Practice Address - Phone:631-767-5386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1782856174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist