Provider Demographics
NPI:1649287103
Name:NISENOFF, CAROLINA D (MD)
Entity type:Individual
Prefix:
First Name:CAROLINA
Middle Name:D
Last Name:NISENOFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CAROLINA
Other - Middle Name:D
Other - Last Name:MILNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:355 BARD AVE
Mailing Address - Street 2:RUMC BEHAVIORAL HEALTH
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-1664
Mailing Address - Country:US
Mailing Address - Phone:917-373-4422
Mailing Address - Fax:
Practice Address - Street 1:355 BARD AVE
Practice Address - Street 2:RUMC BEHAVIORAL HEALTH
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-1664
Practice Address - Country:US
Practice Address - Phone:917-373-4422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0878892084P0800X
NY60.2679162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry