Healthcare Provider Details

I. General information

NPI: 1124494653
Provider Name (Legal Business Name): MRS. JACQUELINE NICOLLET
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. JACQUELINE BOWEN

II. Dates (important events)

Enumeration Date: 08/19/2015
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 E BETHPAGE RD
PLAINVIEW NY
11803-4228
US

IV. Provider business mailing address

VARIETY CHILD LEARNING CENTER 47 HUMPHREY DRIVE
SYOSSET NY
11791
US

V. Phone/Fax

Practice location:
  • Phone: 516-731-5588
  • Fax:
Mailing address:
  • Phone: 516-921-7171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: