Healthcare Provider Details

I. General information

NPI: 1003620808
Provider Name (Legal Business Name): NIKKI DIAMANTOPOULOS ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLETTA DIAMANTOPOULOS ATC

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 ROBBINS LN
SYOSSET NY
11791-6009
US

IV. Provider business mailing address

749 SUNRISE AVE
BELLMORE NY
11710-4524
US

V. Phone/Fax

Practice location:
  • Phone: 516-822-1777
  • Fax:
Mailing address:
  • Phone: 480-221-3350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number002048
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: