Provider Demographics
NPI:1831483486
Name:NICOSIA, CATHERINE JOSEPHINE (RN)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:JOSEPHINE
Last Name:NICOSIA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:JOSEPHINE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:42 10TH ST
Mailing Address - Street 2:
Mailing Address - City:LAKE RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-5440
Mailing Address - Country:US
Mailing Address - Phone:631-714-5554
Mailing Address - Fax:
Practice Address - Street 1:245 UNION AVE
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-1800
Practice Address - Country:US
Practice Address - Phone:631-471-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY610157163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse