Provider Demographics
NPI:1447600382
Name:POTESTIO, NICOLO
Entity Type:Individual
Prefix:
First Name:NICOLO
Middle Name:
Last Name:POTESTIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:
Other - Last Name:LEONARDIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 BRIDGE ST
Mailing Address - Street 2:SUITE 71
Mailing Address - City:IRVINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:10533-1543
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 BRIDGE ST
Practice Address - Street 2:SUITE 71
Practice Address - City:IRVINGTON
Practice Address - State:NY
Practice Address - Zip Code:10533-1543
Practice Address - Country:US
Practice Address - Phone:914-375-3434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0402172251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic