Individual
MS. NICOLE DELLAPORTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
525 E 68TH ST, NEW YORK, NY 10065-4870
(212) 932-4000
Mailing address
1575 4TH ST, WEST BABYLON, NY 11704-4755
(631) 661-3352
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
021928
NY
Other
Enumeration date
04/02/2018
Last updated
04/02/2018
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