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General NPI Number Information
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NPI Number | 1962369652
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Entity Type | Individual
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Provider Name | NICOLE M. ZOMPA
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Gender |
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Dates
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Enumeration Date | 01/06/2026
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Last Update Date | 01/06/2026
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Provider Practice Location Address
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Address Line | 299 HALLOCK AVE
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-1217
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Country | US
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Telephone | 631-469-3076
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Fax |
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Provider Business Mailing Address
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Address Line | 630 S 11TH ST
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-5563
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Country | US
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Telephone | 516-732-0532
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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 |
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