Provider Demographics
NPI:1205303500
Name:SCHORR, NICOLE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:SCHORR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 EMPIRE AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-4835
Mailing Address - Country:US
Mailing Address - Phone:845-499-9873
Mailing Address - Fax:
Practice Address - Street 1:790 EMPIRE AVE UNIT B
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-4835
Practice Address - Country:US
Practice Address - Phone:845-499-9873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022919363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical