Provider Demographics
NPI:1053026807
Name:CHASE, NICOLETTE ASHLEY
Entity type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:ASHLEY
Last Name:CHASE
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 1:44 SUMMER LN
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-6328
Mailing Address - Country:US
Mailing Address - Phone:516-404-5249
Mailing Address - Fax:
Practice Address - Street 1:1 S MARION PL
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-5300
Practice Address - Country:US
Practice Address - Phone:516-415-7348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-17
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007217171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist