MEDICARE: MR. NICHOLAS CANNONE FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F333760	NY

General Provider Information

NPI Number	:	1306950266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NICHOLAS CANNONE FNP

Provider Business Mailing Address
First Line	:	19 HEWITT AVE
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10605-3905
Country	:	US
Telephone Number	:	914-949-3952
Fax Number	:

Provider Business Practice Location Address
First Line	:	121A W 20TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10011-3601
Country	:	US
Telephone Number	:	212-337-9248
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	10/14/2009

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Directions to “ MR. NICHOLAS CANNONE FNP” Practice Location

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