Provider Demographics
NPI:1447698295
Name:CORTES, NICOLE C
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:C
Last Name:CORTES
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 1:3 VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT SINAI
Mailing Address - State:NY
Mailing Address - Zip Code:11766-1728
Mailing Address - Country:US
Mailing Address - Phone:631-236-2032
Mailing Address - Fax:
Practice Address - Street 1:3 VALLEY CT
Practice Address - Street 2:
Practice Address - City:MOUNT SINAI
Practice Address - State:NY
Practice Address - Zip Code:11766-1728
Practice Address - Country:US
Practice Address - Phone:631-236-2032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY720550131174400000X
NY720551131174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist