Active NPI
Nicole Josephine Nibert, PA
- Physician Assistant
- New York, NY
National Provider Identifier
1194052027
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 5601005636
- Practice address
- 1275 York Ave FL 8
New York, NY 10065-6007 - Phone
- (212) 639-6938
- NPI assigned
- Nov 13, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5601005636 | MI | Primary |
Addresses
Primary practice location
1275 York Ave FL 8
New York, NY 10065-6007
Mailing address
1275 Yorkave
New York, NY 10065
Phone (212) 639-6938
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601005636 | MI | MD | Physician Assistant |
Interoperability endpoints
- nnibert95748@mskcc.direct-ci.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1258070400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1528070400000",
"number": "1194052027",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1275 YORKAVE",
"city": "NEW YORK",
"state": "NY",
"postal_code": "10065",
"telephone_number": "212-639-6938"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1275 YORK AVE FL 8",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100656007",
"telephone_number": "212-639-6938"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NIBERT",
"first_name": "NICOLE",
"middle_name": "JOSEPHINE",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-11-13",
"last_updated": "2018-06-04",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MI",
"license": "5601005636",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.