Healthcare Provider Details

I. General information

NPI: 1235449950
Provider Name (Legal Business Name): DAVID EMMANUEL NICOSIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2010
Last Update Date: 10/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 JOHN STREET
AKRON NY
14001
US

IV. Provider business mailing address

42 JOHN STREET
AKRON NY
14001
US

V. Phone/Fax

Practice location:
  • Phone: 716-308-6127
  • Fax:
Mailing address:
  • Phone: 716-308-6127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number474031-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: