Provider Demographics
NPI:1497212484
Name:STOLLMAN, NICOLE COHEN (PA-C)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:COHEN
Last Name:STOLLMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 CLINTON ST LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-4601
Mailing Address - Country:US
Mailing Address - Phone:212-430-6677
Mailing Address - Fax:
Practice Address - Street 1:153 CLINTON ST LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4601
Practice Address - Country:US
Practice Address - Phone:212-430-6677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-26
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA45876363AM0700X
NY026627363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical