Provider Demographics
NPI:1588868160
Name:NEMETH, NICOLE LEA (MD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:LEA
Last Name:NEMETH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MAMARONECK AVENUE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10528-1633
Mailing Address - Country:US
Mailing Address - Phone:914-771-7373
Mailing Address - Fax:914-337-6757
Practice Address - Street 1:500 MAMARONECK AVENUE
Practice Address - Street 2:SUITE 211
Practice Address - City:HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10528-1633
Practice Address - Country:US
Practice Address - Phone:914-771-7373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6308-(60 TEMP)2086S0122X
NY2485622086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
465732592OtherMYUTMB 465732592-COMMERCIAL NUMBER