Provider Demographics
NPI:1174621692
Name:ESQUENET, NICOLE M (DO)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:ESQUENET
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 SAGAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-1919
Mailing Address - Country:US
Mailing Address - Phone:516-909-5888
Mailing Address - Fax:516-629-6375
Practice Address - Street 1:393 SAGAMORE AVE
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-1919
Practice Address - Country:US
Practice Address - Phone:516-909-5888
Practice Address - Fax:516-629-6375
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226373207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02598694Medicaid
I21070Medicare UPIN
NY02598694Medicaid