Most Relevant Information
Provider Data
| NPI Number: | 1003513896 |
| Provider Name: | JOAN ELIZABETH NICOTRA |
| Entity Type: | Individual |
| Taxonomy Code: | 174400000X |
| Specialty: | Specialist |
| License Number: |
Most Important Dates
| Enumeration Date: | 02/13/2023 |
| Last Updated: | 02/13/2023 |
Provider Practice Location
299 HALLOCK AVE
PORT JEFFERSON STATION
NY
117761217
Practice Location Phone/Fax
| Phone: | 6314734284 |
| Fax: |
Provider Mailing Location
4 KIMBERLEY CT
LAKE GROVE
NY
117552753
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |