Healthcare Provider Details

I. General information

NPI: 1497219364
Provider Name (Legal Business Name): PRINCYMOL NICEMON JOSEPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2019
Last Update Date: 06/10/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NORTHSHORE UNIVERSITY HOSPITAL, DEPARTMENT OF NEUROSUR 300 COMMUNITY DRIVE
MANHASSET NY
11030
US

IV. Provider business mailing address

NORTHSHORE UNIVERSITY HOSPITAL, NEUROSURGERY, 9 TOWER 300 COMMUNITY DRIVE
MANHASSET NY
11030-1636
US

V. Phone/Fax

Practice location:
  • Phone: 516-562-4300
  • Fax:
Mailing address:
  • Phone: 516-562-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number308905
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: