Provider Demographics
NPI:1104286756
Name:SEMENOVSKI, NATALIE (NP-C)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:SEMENOVSKI
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3457 NOSTRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-5131
Mailing Address - Country:US
Mailing Address - Phone:718-535-5100
Mailing Address - Fax:
Practice Address - Street 1:3457 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-5131
Practice Address - Country:US
Practice Address - Phone:718-535-5100
Practice Address - Fax:718-449-9028
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-24
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2304659363L00000X
NYF307606-1363L00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400145270Medicare PIN
NYG400298817Medicare PIN