Healthcare Provider Details

I. General information

NPI: 1669360814
Provider Name (Legal Business Name): NICOLETTE CERBONE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 TODT HILL RD STE 205
STATEN ISLAND NY
10314-4528
US

IV. Provider business mailing address

1894 WALTON AVE
BRONX NY
10453-6018
US

V. Phone/Fax

Practice location:
  • Phone: 718-447-0781
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number357128
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: