Provider Demographics
NPI:1902355704
Name:ROTONDI, NICOLE V (LAC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:V
Last Name:ROTONDI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 HAMPTON VISTA DR
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949-2859
Mailing Address - Country:US
Mailing Address - Phone:516-729-8508
Mailing Address - Fax:
Practice Address - Street 1:872 MIDDLE COUNTRY RD
Practice Address - Street 2:SUITE 5&6
Practice Address - City:SAINT JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780-3223
Practice Address - Country:US
Practice Address - Phone:631-360-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-22
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001352171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist