Healthcare Provider Details

I. General information

NPI: 1336957794
Provider Name (Legal Business Name): NICOLE WEBER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2024
Last Update Date: 12/24/2025
Certification Date: 12/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 CENTRAL AVE FL 3
BETHPAGE NY
11714-3927
US

IV. Provider business mailing address

185 CENTRAL AVE FL 3
BETHPAGE NY
11714-3927
US

V. Phone/Fax

Practice location:
  • Phone: 516-758-8600
  • Fax:
Mailing address:
  • Phone: 516-758-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number354971
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: