1407748734 NPI number — NICOLE ROSE TESORIERO REGISTERED NURSE

Table of content: NICOLE ROSE TESORIERO REGISTERED NURSE (NPI 1407748734)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407748734 NPI number — NICOLE ROSE TESORIERO REGISTERED NURSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TESORIERO
Provider First Name:
NICOLE
Provider Middle Name:
ROSE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
REGISTERED NURSE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TESORIERO
Provider Other First Name:
NICOLE
Provider Other Middle Name:
ROSE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
NICOLE TESORIERO RN
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1407748734
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 CARSTON ST W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SELDEN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11784-2318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-627-4487
Provider Business Mailing Address Fax Number:
631-627-4487

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7 CARSTON ST W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SELDEN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11784-2318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-627-4487
Provider Business Practice Location Address Fax Number:
631-627-4487
Provider Enumeration Date:
07/21/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  917395 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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