Provider Demographics
NPI:1780049452
Name:INDICH, NAOMI (CPNP)
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:INDICH
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 OCEAN PKWY APT 2H
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-3410
Mailing Address - Country:US
Mailing Address - Phone:773-991-8393
Mailing Address - Fax:
Practice Address - Street 1:1000 OCEAN PKWY
Practice Address - Street 2:APT 2H
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-3425
Practice Address - Country:US
Practice Address - Phone:773-991-8393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY38382596363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics