Healthcare Provider Details

I. General information

NPI: 1558760413
Provider Name (Legal Business Name): PATRICIA NICOLETTA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2014
Last Update Date: 08/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 W CEDARVIEW AVE
STATEN ISLAND NY
10306-1709
US

IV. Provider business mailing address

103 W CEDARVIEW AVE
STATEN ISLAND NY
10306-1709
US

V. Phone/Fax

Practice location:
  • Phone: 718-351-3850
  • Fax:
Mailing address:
  • Phone: 718-351-3850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number002361
License Number StateNY

VIII. Authorized Official

Name: MRS. PATRICIA NICOLETTA
Title or Position: SENIOR OCCUPATIONAL THERAPIST
Credential: OTR
Phone: 718-351-3850