Provider Demographics
NPI:1326877168
Name:ABBENE, NICOLE (NP)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:ABBENE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 OAKSIDE RD
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-1545
Mailing Address - Country:US
Mailing Address - Phone:631-352-9326
Mailing Address - Fax:
Practice Address - Street 1:554 LARKFIELD RD STE 10G
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-4205
Practice Address - Country:US
Practice Address - Phone:631-230-6644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307328363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty