Provider Demographics
NPI:1497219364
Name:JOSEPH, PRINCYMOL NICEMON
Entity Type:Individual
Prefix:
First Name:PRINCYMOL
Middle Name:NICEMON
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NORTHSHORE UNIVERSITY HOSPITAL, NEUROSURGERY, 9 TOWER
Mailing Address - Street 2:300 COMMUNITY DRIVE
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-1636
Mailing Address - Country:US
Mailing Address - Phone:516-562-4300
Mailing Address - Fax:
Practice Address - Street 1:NORTHSHORE UNIVERSITY HOSPITAL, DEPARTMENT OF NEUROSUR
Practice Address - Street 2:300 COMMUNITY DRIVE
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030
Practice Address - Country:US
Practice Address - Phone:516-562-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-25
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308905363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health