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General NPI Number Information
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NPI Number | 1316808728
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Entity Type | Individual
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Provider Name | NICHOLE PHILLIP-LEITH LPN
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Gender | Female
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Dates
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Enumeration Date | 11/24/2025
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 45 CROSSWAY E
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City | BOHEMIA
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State | NY
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Zip | 11716-1204
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Country | US
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Telephone | 631-585-0100
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Fax |
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Provider Business Mailing Address
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Address Line | 833 MICHIGAN AVE
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City | BELLPORT
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State | NY
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Zip | 11713-1505
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Country | US
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Telephone | 631-218-4949
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 314650
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License Number State | NY
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