Active NPI
Nicole Marie Willis
- Specialist
- Melville, NY
National Provider Identifier
1235519307
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- Practice address
- 538 Broadhollow Rd Ste 202
Melville, NY 11747-3668 - Phone
- (631) 385-7780
- NPI assigned
- Jun 4, 2015
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | Primary |
Addresses
Primary practice location
538 Broadhollow Rd Ste 202
Melville, NY 11747-3668
Mailing address
9 Bear Street
Selden, NY 11784
Phone (631) 428-2952
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1433376000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1433376000000",
"number": "1235519307",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9 BEAR STREET",
"city": "SELDEN",
"state": "NY",
"postal_code": "11784",
"telephone_number": "631-428-2952"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "538 BROADHOLLOW RD STE 202",
"city": "MELVILLE",
"state": "NY",
"postal_code": "117473668",
"telephone_number": "631-385-7780"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "NICOLE",
"middle_name": "MARIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-06-04",
"last_updated": "2015-06-04",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Melville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.