Provider Demographics
NPI:1689756025
Name:BODEA- CRISAN, NICOLETA CAMELIA (MD)
Entity Type:Individual
Prefix:
First Name:NICOLETA CAMELIA
Middle Name:
Last Name:BODEA- CRISAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NICOLETA CAMELIA
Other - Middle Name:
Other - Last Name:BODEA CRISAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:312 MAIN ST
Mailing Address - Street 2:APARTMENT B
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-2110
Mailing Address - Country:US
Mailing Address - Phone:516-801-4249
Mailing Address - Fax:
Practice Address - Street 1:998 CROOKED HILL RD
Practice Address - Street 2:
Practice Address - City:W BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-1043
Practice Address - Country:US
Practice Address - Phone:631-761-2191
Practice Address - Fax:631-761-2816
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2361912084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology