Provider Demographics
NPI:1265580625
Name:NOZDROVICKY, CATHERINE (NP)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:NOZDROVICKY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 BEACH 20TH ST
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-3618
Mailing Address - Country:US
Mailing Address - Phone:516-356-9569
Mailing Address - Fax:516-593-1046
Practice Address - Street 1:228 BEACH 20TH ST
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-3618
Practice Address - Country:US
Practice Address - Phone:516-356-9569
Practice Address - Fax:516-593-1046
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF430221363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP68677Medicare UPIN