Healthcare Provider Details

I. General information

NPI: 1689032864
Provider Name (Legal Business Name): NICOLE MIZIOLEK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2016
Last Update Date: 02/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 ELM PL
HASTINGS ON HUDSON NY
10706-1703
US

IV. Provider business mailing address

33 ELM PL
HASTINGS ON HUDSON NY
10706-1703
US

V. Phone/Fax

Practice location:
  • Phone: 646-705-4270
  • Fax:
Mailing address:
  • Phone: 646-705-4270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number005214
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: