Provider Demographics
NPI:1891830766
Name:HARRINGTON, NICOLLE C (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:NICOLLE
Middle Name:C
Last Name:HARRINGTON
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:MS
Other - First Name:NICOLLE
Other - Middle Name:C
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICIAN ASSISTANT
Mailing Address - Street 1:3003 NEW HYDE PARK RD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1214
Mailing Address - Country:US
Mailing Address - Phone:516-354-5700
Mailing Address - Fax:516-488-8048
Practice Address - Street 1:3003 NEW HYDE PARK RD
Practice Address - Street 2:SUITE 401
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1214
Practice Address - Country:US
Practice Address - Phone:516-354-5700
Practice Address - Fax:516-488-8048
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008818363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant