Individual
MARK NISTICO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
23 MAYAPPLE WAY, MALTA, NY 12020-4390
(518) 818-4492
Mailing address
23 MAYAPPLE WAY, MALTA, NY 12020-4390
(518) 818-4492
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
623-121
NY
Other
Enumeration date
05/18/2020
Last updated
05/18/2020
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