Provider Demographics
NPI:1508239294
Name:BRUNNHOELZL, NICOLE (MS, ATC/L)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:BRUNNHOELZL
Suffix:
Gender:F
Credentials:MS, ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 WOLCOTT RD
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-1930
Mailing Address - Country:US
Mailing Address - Phone:516-852-7028
Mailing Address - Fax:
Practice Address - Street 1:1300 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-1886
Practice Address - Country:US
Practice Address - Phone:516-663-9099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002879172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker