Provider Demographics
NPI:1497121271
Name:NUNZIO SIGNORELLA, LLC
Entity Type:Organization
Organization Name:NUNZIO SIGNORELLA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:NUNZIO
Authorized Official - Middle Name:
Authorized Official - Last Name:SIGNORELLA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:347-675-9873
Mailing Address - Street 1:159 MADISON AVE, 3I
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5434
Mailing Address - Country:US
Mailing Address - Phone:347-675-9873
Mailing Address - Fax:646-707-0109
Practice Address - Street 1:80 E. 11TH STREET
Practice Address - Street 2:610
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-6819
Practice Address - Country:US
Practice Address - Phone:347-675-9873
Practice Address - Fax:646-707-0109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YA0400X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02542107Medicaid
NYQ03275Medicare UPIN
NY06031Medicare PIN