Provider Demographics
NPI:1558831560
Name:VIRAG, NICHOLE (LM, CM, MSW)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:VIRAG
Suffix:
Gender:F
Credentials:LM, CM, MSW
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:
Other - Last Name:VIRAG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:442 STERLING PL APT 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-4535
Mailing Address - Country:US
Mailing Address - Phone:315-879-5449
Mailing Address - Fax:
Practice Address - Street 1:4714 16TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-1197
Practice Address - Country:US
Practice Address - Phone:718-840-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-03
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY374J00000X
NYF002267367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No374J00000XNursing Service Related ProvidersDoula