Provider Demographics
NPI:1164480778
Name:DEPAOLA, NINA (PT)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:DEPAOLA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:
Other - Last Name:BRUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:801 MERRICK AVE
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554
Mailing Address - Country:US
Mailing Address - Phone:516-393-8900
Mailing Address - Fax:516-393-8869
Practice Address - Street 1:801 MERRICK AVE
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554
Practice Address - Country:US
Practice Address - Phone:516-393-8900
Practice Address - Fax:516-393-8869
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0098901225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q39321Medicare ID - Type Unspecified