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NPI Code Detail

MEDICARE: JENNIFER ANN NICOLELLA

MEDICARE: JENNIFER ANN NICOLELLA
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
1224Z00000XOccupational Therapy Assistant006269-1NY

General Provider Information

NPI Number : 1720279771
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER ANN NICOLELLA
Provider Business Mailing Address
First Line : 19 PLEASANT AVE
Second Line :
City : AMSTERDAM
State : NY
Zip : 12010-2616
Country : US
Telephone Number : 518-478-2151
Fax Number :
Provider Business Practice Location Address
First Line : 100 SANDY DR
Second Line :
City : AMSTERDAM
State : NY
Zip : 12010-8191
Country : US
Telephone Number : 518-843-3503
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/06/2007
Last Update Date : 08/06/2007

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Directions to “ JENNIFER ANN NICOLELLA ” Practice Location

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