Healthcare Provider Details

I. General information

NPI: 1497212484
Provider Name (Legal Business Name): NICOLE COHEN STOLLMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 05/09/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 ATLANTIC AVE STE 202
BROOKLYN NY
11201-6720
US

IV. Provider business mailing address

161 ATLANTIC AVE STE 202
BROOKLYN NY
11201-6720
US

V. Phone/Fax

Practice location:
  • Phone: 212-430-6677
  • Fax:
Mailing address:
  • Phone: 212-430-6677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number45876
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number026627
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: