Provider Demographics
NPI:1497168868
Name:EGENBERGER, NICOLE PHYLLIS KATALIN (ND)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:PHYLLIS KATALIN
Last Name:EGENBERGER
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 SULLIVAN ST STE 3B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-1354
Mailing Address - Country:US
Mailing Address - Phone:646-485-5229
Mailing Address - Fax:212-254-2216
Practice Address - Street 1:214 SULLIVAN ST STE 3B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-1354
Practice Address - Country:US
Practice Address - Phone:646-485-5229
Practice Address - Fax:212-254-2216
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT304175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath