Healthcare Provider Details

I. General information

NPI: 1013831932
Provider Name (Legal Business Name): NICOLE ROSE KANDINOVA MD P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

544 NOSTRAND AVE
BROOKLYN NY
11216-2013
US

IV. Provider business mailing address

544 NOSTRAND AVE
BROOKLYN NY
11216-2013
US

V. Phone/Fax

Practice location:
  • Phone: 917-724-1917
  • Fax:
Mailing address:
  • Phone: 917-724-1917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NICOLE ROSE KANDINOVA
Title or Position: OWNER
Credential: MD
Phone: 718-791-8262