NPI Code Detail JSON Logo

1568839421 NPI number — NICOLE ROSE PETROCELLI R.D.

NPI Number: 1568839421
Health Care Provider/Practitioner: NICOLE ROSE PETROCELLI R.D.

Information about “1568839421” NPI (NICOLE ROSE PETROCELLI R.D.) exists in 1568839421 in HTML format HTML  |  1568839421 in plain Text format TXT  |  1568839421 in PDF (Portable Document Format) PDF  |  1568839421 in an XML format XML  formats.

NPI Number : 1568839421 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1568839421",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PETROCELLI",
    "FirstName": "NICOLE",
    "MiddleName": "ROSE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "R.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MARCIANTE",
    "OtherFirstName": "NICOLE",
    "OtherMiddleName": "ROSE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "R.D.",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "24 HERITAGE LN N",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MILLER PLACE",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "11764-3316",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "631-327-7934",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "24 HERITAGE LN N",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MILLER PLACE",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "11764-3316",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "631-327-7934",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/27/2015",
    "LastUpdateDate": "08/27/2015",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "133N00000X",
          "TaxonomyName": "Nutritionist",
          "LicenseNumber": "1057815",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "133NN1002X",
          "TaxonomyName": "Nutrition Education Nutritionist",
          "LicenseNumber": "1057815",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "133V00000X",
          "TaxonomyName": "Registered Dietitian",
          "LicenseNumber": "1057815",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "133VN1004X",
          "TaxonomyName": "Pediatric Nutrition Registered Dietitian",
          "LicenseNumber": "1057815",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "133VN1005X",
          "TaxonomyName": "Renal Nutrition Registered Dietitian",
          "LicenseNumber": "1057815",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "133VN1006X",
          "TaxonomyName": "Metabolic Nutrition Registered Dietitian",
          "LicenseNumber": "1057815",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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