Provider Demographics
NPI:1669734281
Name:FATTIZZI, NICOLE JEAN
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:JEAN
Last Name:FATTIZZI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 139TH ST
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-2336
Mailing Address - Country:US
Mailing Address - Phone:347-582-1826
Mailing Address - Fax:
Practice Address - Street 1:1308 139TH ST
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-2336
Practice Address - Country:US
Practice Address - Phone:347-582-1826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-10
Last Update Date:2012-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1924568174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist