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Individual

NICOLE ELIZABETH DORNICIK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
AU.D.

Contact information

Practice address
292 SHADE TREE LN, RIVERHEAD, NY 11901-5020
(631) 727-8050
Mailing address
560 WHITE PLAINS RD, SUITE 560, TARRYTOWN, NY 10591-5113
(631) 727-8050

Taxonomy

Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
002488-1
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
A400091836
MEDICARE PARTICIPATION NUMBER (PTAN #)
NY
Enumeration date
07/10/2013
Last updated
04/06/2015
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