Provider Demographics
NPI:1073369112
Name:CUMBERBATCH, NADINE
Entity type:Individual
Prefix:
First Name:NADINE
Middle Name:
Last Name:CUMBERBATCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22919 MERRICK BLVD
Mailing Address - Street 2:
Mailing Address - City:LAURELTON
Mailing Address - State:NY
Mailing Address - Zip Code:11413-2108
Mailing Address - Country:US
Mailing Address - Phone:917-299-5765
Mailing Address - Fax:
Practice Address - Street 1:15041 116TH DR
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-1511
Practice Address - Country:US
Practice Address - Phone:917-299-5765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist