NICOLE IRENE BRODERICK (NPI# 1396375747) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396375747 |
| Entity Type | Individual |
| Full Name | NICOLE IRENE BRODERICK |
| Credential | LMT |
| Practice Address |
99 E Main St Ste 1 East Islip NY 11730-2538 |
| Practice Telephone | 6316478324 |
| Practice Fax Number | 6313520051 |
| Mailing Telephone | 6316478324 |
| Mailing Fax Number | 6313520051 |
| Enumeration Date | 2020-01-23 |
| Last Update Date | 2020-01-23 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 225700000X | Massage Therapist | 016018-1 | NY | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982243945 | Nicole Broderick | Speech-Language Pathologist | 638 Brandywine Pkwy, West Chester, PA 19380-4278 | 2019-12-22 |
| Street Address |
99 E MAIN ST STE 1 |
| City | EAST ISLIP |
| State | NY |
| Zip Code | 11730-2538 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568092583 | Exchange Ambulance Corporation of The Islips | Ambulance | 190 Carleton Avenue, East Islip, NY 11730 | 2020-01-17 |
| 1629422639 | Wanda Chisolm | Counselor | 107 East Main Street, East Islip, NY 11730 | 2016-04-15 |
| 1689040990 | Ryan George Baist | Pharmacist | 18 Argyle Drive, East Islip, NY 11730 | 2015-08-20 |
| 1225448855 | Michael John Desivo | Dentist | 228 East Main St, East Islip, NY 11730 | 2014-05-05 |
| 1306279401 | Eileen Henry | Specialist | 81 Country Village Lane, East Islip, NY 11730 | 2013-08-13 |
| 1124306659 | Carol A Ryan-behr | Licensed Practical Nurse | 145 Woodland Ave, East Islip, NY 11730 | 2011-08-02 |
| 1154651768 | Helene Dellas-dibona | Social Worker | 216 Carleton Avenue, East Islip, NY 11730 | 2010-01-04 |
| 1952513921 | Lorraine G Ballou | Social Worker | 31 Sherwood Drive, East Islip, NY 11730 | 2007-05-04 |
| 1235271362 | Robert Anthony Domozych Jr. | Dentist | 127 West Main Street, East Islip, NY 11730 | 2007-02-13 |
| 1477614766 | Kathleen O'neill | Counselor | 265 East Main Street, Tranquility Counseling, East Islip, NY 11730 | 2006-12-12 |
| Find all providers in zip 11730 | ||||
| Taxonomy Code | 225700000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Massage Therapist |
| An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366068926 | Rm Massage Therapy PC | Massage Therapist | 269 E Main St, East Islip, NY 11730-2730 | 2020-06-19 |
| 1144871146 | Lionel Gondolfo | Massage Therapist | 269 E Main St, East Islip, NY 11730-2730 | 2019-09-23 |
| 1962764241 | Loretta M Dalia | Massage Therapist | 146 E Main St, East Islip, NY 11730-2640 | 2012-06-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548861354 | Stephen Quinn | Massage Therapist | 72 Steuben Rd, Garrison, NY 10524-7417 | 2020-11-06 |
| 1750982567 | Moises Payero | Massage Therapist | 407 Beach 20th St Apt 3b, Far Rockaway, NY 11691-3638 | 2020-11-06 |
| 1447851589 | Emily Nicole Bagnasco | Massage Therapist | 827 S 5th St, Lindenhurst, NY 11757-5625 | 2020-11-04 |
| 1053912162 | Chanel Marie Poole | Massage Therapist | 1234 Abbott Rd Ste 230, Lackawanna, NY 14218-1946 | 2020-11-04 |
| 1144821562 | Deping Song | Massage Therapist | 4002 Bowne St, #228, Flushing, NY 11354-6142 | 2020-11-03 |
| 1881295400 | Yoshiko Yamamoto | Massage Therapist | 4914 43rd Ave Apt 3, Woodside, NY 11377-4598 | 2020-11-02 |
| 1780285254 | Devante Quareed Thompson | Massage Therapist | 8944 Metropolitan Ave # 89-44, Rego Park, NY 11374-5331 | 2020-11-02 |
| 1396345062 | Amy Nadine Baker | Massage Therapist | 611 Broadway Rm 814, New York, NY 10012-0032 | 2020-10-30 |
| 1972102655 | Maria Carmen Tapia | Massage Therapist | 14749 72nd Dr Apt 3d, Flushing, NY 11367-2533 | 2020-10-22 |
| 1346849262 | Reddy for Acupuncture | Massage Therapist | 2807 Merrick Rd, Bellmore, NY 11710-5724 | 2020-10-21 |
| Find all providers with the same taxonomy | ||||
| City | EAST ISLIP |
| Zip Code | 11730 |
Please comment or provide details below to improve the information on NICOLE IRENE BRODERICK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.