Provider Demographics
NPI:1538105887
Name:NOCERA, JINA BAE (MD)
Entity Type:Individual
Prefix:MRS
First Name:JINA
Middle Name:BAE
Last Name:NOCERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:PALATINE BRIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:13428-9715
Mailing Address - Country:US
Mailing Address - Phone:518-673-5212
Mailing Address - Fax:518-673-4337
Practice Address - Street 1:154 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:PALATINE BRIDGE
Practice Address - State:NY
Practice Address - Zip Code:13428-9715
Practice Address - Country:US
Practice Address - Phone:518-673-5212
Practice Address - Fax:518-673-4337
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224602208M00000X
FLME110184207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3205029Medicaid
FLP00995221OtherRR MEDICARE
VT1013986Medicaid
NY02257876Medicaid
NYP00371407OtherRR MEDICARE
FLH09854Medicare UPIN
NYP00371407OtherRR MEDICARE
FLP00995221OtherRR MEDICARE
NY02257876Medicaid
NYRB0877Medicare PIN