Healthcare Provider Details

I. General information

NPI: 1083558944
Provider Name (Legal Business Name): NICOLE ADIATU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 STATE ST APT 2E
HACKENSACK NJ
07601-5415
US

IV. Provider business mailing address

105 STATE ST APT 2E
HACKENSACK NJ
07601-5415
US

V. Phone/Fax

Practice location:
  • Phone: 516-395-1774
  • Fax:
Mailing address:
  • Phone: 516-395-1774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number561427-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: