Provider Demographics
NPI:1558760413
Name:PATRICIA NICOLETTA
Entity Type:Organization
Organization Name:PATRICIA NICOLETTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:NICOLETTA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:718-351-3850
Mailing Address - Street 1:103 W CEDARVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-1709
Mailing Address - Country:US
Mailing Address - Phone:718-351-3850
Mailing Address - Fax:
Practice Address - Street 1:103 W CEDARVIEW AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-1709
Practice Address - Country:US
Practice Address - Phone:718-351-3850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-17
Last Update Date:2014-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002361283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital