Healthcare Provider Details

I. General information

NPI: 1871356477
Provider Name (Legal Business Name): MRS. NICOLE MURN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 SCHOOL LN
HUNTINGTON NY
11743-1039
US

IV. Provider business mailing address

203 OLD FIELD RD
CENTERPORT NY
11721-1727
US

V. Phone/Fax

Practice location:
  • Phone: 631-367-8800
  • Fax:
Mailing address:
  • Phone: 631-312-6377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: