MEDICARE: NICOLE TAUB PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	F402274-1	NY

General Provider Information

NPI Number	:	1730688862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE TAUB PMHNP

Provider Business Mailing Address
First Line	:	704 MIDDLE RD
Second Line	:
City	:	BAYPORT
State	:	NY
Zip	:	11705-1920
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	704 MIDDLE RD
Second Line	:
City	:	BAYPORT
State	:	NY
Zip	:	11705-1920
Country	:	US
Telephone Number	:	631-664-6563
Fax Number	:

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

Provider Enumeration Date	:	02/05/2018
Last Update Date	:	01/09/2026

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