Nicole S Fader, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

015711-1 Issued in NY

Practice address

202 W Park Ave
Suite 201
Long Beach, NY 11561-3212

Phone

(516) 606-5473

NPI assigned

Aug 7, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Nicky Fader Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1186444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1186444800000",
    "number": "1275724924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 W PARK AVE",
            "address_2": "SUITE 201",
            "city": "LONG BEACH",
            "state": "NY",
            "postal_code": "115613212",
            "telephone_number": "516-606-5473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 W PARK AVE",
            "address_2": "SUITE 201",
            "city": "LONG BEACH",
            "state": "NY",
            "postal_code": "115613212",
            "telephone_number": "516-606-5473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FADER",
        "first_name": "NICOLE",
        "middle_name": "S",
        "name_prefix": "Miss",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-08-07",
        "last_updated": "2007-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "NY",
            "license": "015711-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICKY",
            "last_name": "FADER",
            "credential": "LMT",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Massage Therapist in Long Beach, NY
• Providers in Long Beach, NY by specialty
• Massage Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.