Provider Demographics
NPI:1043354293
Name:NICOLETTE, SALVATORE F SR (RT(R), RDMS,)
Entity type:Individual
Prefix:
First Name:SALVATORE
Middle Name:F
Last Name:NICOLETTE
Suffix:SR
Gender:M
Credentials:RT(R), RDMS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 KRAFT DR
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:13502-1126
Mailing Address - Country:US
Mailing Address - Phone:315-733-8393
Mailing Address - Fax:
Practice Address - Street 1:14 KRAFT DR
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:NY
Practice Address - Zip Code:13502-1126
Practice Address - Country:US
Practice Address - Phone:315-733-8393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2396742471V0105X
NY335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography
No335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier