Provider Demographics
NPI:1609818772
Name:NOLAN, PATRICIA M (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:M
Last Name:NOLAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:55 WATER ST
Mailing Address - Street 2:12TH FL., CREDENTIALING
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10041-0004
Mailing Address - Country:US
Mailing Address - Phone:646-680-2888
Mailing Address - Fax:516-542-5556
Practice Address - Street 1:640 HAWKINS AVE
Practice Address - Street 2:
Practice Address - City:LAKE RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-2324
Practice Address - Country:US
Practice Address - Phone:631-737-0100
Practice Address - Fax:631-417-1117
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2017-11-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY144378207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00704930Medicaid
NY00704930Medicaid
NYA400161157Medicare PIN