Individual
JACLYN ANNE NICOLIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
525 E 68TH ST, NEW YORK, NY 10065-4870
(845) 926-4968
Mailing address
333 E 49TH ST, APT. 2H, NEW YORK, NY 10017-1680
(631) 278-2599
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1558819680
—
NY
Enumeration date
09/19/2016
Last updated
01/16/2018
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