Provider Demographics
NPI:1962019331
Name:ALBANESE, NICOLE RENAE (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:RENAE
Last Name:ALBANESE
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:ALBANESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:726 FRANCIS DR
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-1039
Mailing Address - Country:US
Mailing Address - Phone:516-305-2941
Mailing Address - Fax:
Practice Address - Street 1:5 DAKOTA DR STE 200
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1109
Practice Address - Country:US
Practice Address - Phone:631-752-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025025225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics