Basic Information
| Provider Information | |||||||||
| NPI: | 1619131430 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEVADUNSKY | ||||||||
| FirstName: | NICOLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1695 EASTCHESTER RD | ||||||||
| Address2: | SUITE 602 | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104612374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184058020 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3332 ROCHAMBEAU CENTENNIAL WOMEN'S CENTER | ||||||||
| Address2: | SUITE C | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104676110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189204794 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2008 | ||||||||
| LastUpdateDate: | 05/12/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 230012 | NY | Y | Other Service Providers | Specialist |
No ID Information.