Healthcare Provider Details

I. General information

NPI: 1053256461
Provider Name (Legal Business Name): NICKEY BARCOO RDMS, RVT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 N MILL ST STE 113
NYACK NY
10960-3015
US

IV. Provider business mailing address

9 N MILL ST STE 113
NYACK NY
10960-3015
US

V. Phone/Fax

Practice location:
  • Phone: 845-875-7554
  • Fax:
Mailing address:
  • Phone: 845-875-7554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number125774
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number125774
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: