Provider Demographics
NPI:1285483131
Name:HORAK, NICOLE MARIE (MSED)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:HORAK
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2509 MARSHALL DR
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-2617
Mailing Address - Country:US
Mailing Address - Phone:516-661-7282
Mailing Address - Fax:
Practice Address - Street 1:1075 PORTION RD STE 12
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-2256
Practice Address - Country:US
Practice Address - Phone:631-320-1599
Practice Address - Fax:631-561-4194
Is Sole Proprietor?:No
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist