Healthcare Provider Details

I. General information

NPI: 1881032233
Provider Name (Legal Business Name): NICOLE AUDREY SZABO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2013
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5616 6TH AVE
BROOKLYN NY
11220-3419
US

IV. Provider business mailing address

6906 18TH AVE
BROOKLYN NY
11204-5048
US

V. Phone/Fax

Practice location:
  • Phone: 718-439-5440
  • Fax: 718-567-9442
Mailing address:
  • Phone: 347-560-6233
  • Fax: 347-560-6237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number286022
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: