Provider Demographics
NPI:1689473118
Name:CONLEY, NICOLE DOLORES
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:DOLORES
Last Name:CONLEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 BI COUNTY BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-3931
Mailing Address - Country:US
Mailing Address - Phone:516-393-8330
Mailing Address - Fax:
Practice Address - Street 1:140 SUSSEX PL APT 15
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-3921
Practice Address - Country:US
Practice Address - Phone:516-393-8330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-08
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health