Provider Demographics
NPI:1528639903
Name:DRUCKMAN, NICOLE GRACE
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:GRACE
Last Name:DRUCKMAN
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 1:50 MICHAEL DR
Mailing Address - Street 2:
Mailing Address - City:OLD BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11804-1524
Mailing Address - Country:US
Mailing Address - Phone:516-457-5961
Mailing Address - Fax:
Practice Address - Street 1:50 MICHAEL DR
Practice Address - Street 2:
Practice Address - City:OLD BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11804-1524
Practice Address - Country:US
Practice Address - Phone:516-457-5961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist