Provider Demographics
NPI:1619858263
Name:PRAKOPE, NINA MARIE (NP)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:MARIE
Last Name:PRAKOPE
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 1:1443 RHODE AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-2032
Mailing Address - Country:US
Mailing Address - Phone:516-319-0749
Mailing Address - Fax:
Practice Address - Street 1:100 VETERANS BLVD STE 1
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-4945
Practice Address - Country:US
Practice Address - Phone:516-882-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-10
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF31238501207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease