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General NPI Number Information
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NPI Number | 1003624669
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Entity Type | Individual
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Provider Name | NICOLE TAYLOR TROTTA
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Gender | Female
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Dates
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Enumeration Date | 12/27/2024
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Last Update Date | 12/27/2024
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Provider Practice Location Address
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Address Line | 99 CENTRAL AVE
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City | AMITYVILLE
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State | NY
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Zip | 11701-3537
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Country | US
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Telephone | 516-317-9284
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Fax |
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Provider Business Mailing Address
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Address Line | 2849 NICOLE CT
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City | OCEANSIDE
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State | NY
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Zip | 11572-3349
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Country | US
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Telephone | 516-286-9255
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | NY
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