Look up the most recent NPI and PECOS records

Nicole Innace

Specialist

Other Service Providers

45 Timber Ridge Dr, Holbrook, NY 11741-4142

PECOS Enrollment

Based on the most recent information from CMS, provider Nicole Innace does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 12:04 PM.

Profile Details

Provider ID
1578974630
Provider Type
Individual
Full Name
Innace, Nicole
Gender
Female

Sole Proprietor
Yes
Enumeration Date
5/12/2014
Last Updated
4/10/2015

Contact Information

Practice Location

45 Timber Ridge Dr, Holbrook, NY 11741-4142

(631) 472-8162

Unlisted Fax

Mailing Location

32 Kenwood Dr, Bohemia, NY 11716-1314

(631) 472-8162

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 174400000X Primary	Description Specialist Other Service Providers	License 353185091 New York
Code 174400000X	Description Specialist Other Service Providers	License 415945101 New York
Code 174400000X	Description Specialist Other Service Providers	License 800217131 New York

Nicole Innace

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Code

Description

License

Arthurs, Emily

Slater, Jami M

Hertel, Nancy Ellen

Panebianco, Alexa

Bauernfeind, Erika Lynne

O Mahony, Karen Ann

Mariano, Joy

Greenberg & Weiner Eye Physicians And Surgeons, P.C.

Forese, Elizabeth

Scanlan, Christina Marie