NICOLE ANN FORMAN FNP
NPI 1184570533
Nurse Practitioner - Family in Stony Brook, NY

Q: What is Nicole Forman's NPI number?

The NPI number for Nicole Forman is 1184570533. It was assigned to this individual provider in the NPPES registry on March 9, 2026.

Q: What is Nicole Forman's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Q: When was this NPI record last updated?

The NPPES record for Nicole Forman was last updated on March 9, 2026. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since March 09, 2026PECOS EnrolledAccepts Medicare Assignment

100 NICOLLS RD, HSC 16-047, STONY BROOK, NY 11794(631) 444-3457 Get Directions Write a Review

NPPES record last updated: March 9, 2026. Verified against the NPPES registry weekly; last sync: July 26, 2026.

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About Nicole Ann Forman Fnp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NICOLE ANN FORMAN FNP (NPI 1184570533) is an individual family provider in Stony Brook, New York, licensed in New York (F357935) and active in the NPI registry since March 2026. She is enrolled in Medicare PECOS and is a graduate of Other (2025).

NPPES Registry Identity

NPI1184570533

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameNICOLE ANN FORMANCredential: FNP

Location Address100 NICOLLS RD, HSC 16-047Stony Brook, NY 11794

Mailing Address100 Nicolls Rd, Hsc 16-047Stony Brook, NY 11794 · (631) 444-3457

Phone(631) 444-3457

Sole ProprietorYes

Medical School CMSOtherGraduated 2025

Enumeration DateMarch 9, 2026

NPPES CertifiedMarch 8, 2026

✔ NPI 1184570533 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

License✔ Licensed in NY · F357935

100 NICOLLS RD, Stony Brook, NY 11794

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Nicole Ann Forman Fnp is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID4082184411

PECOS Enrollment IDI20260527003195

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 11794 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$105.06 typical visit price

range $67.40 – $203.53

Typical copayment $26.26 (range $16.85 – $50.88)

Most-billed visit code 99203

Established Patient

$117.62 typical visit price

range $21.66 – $164.45

Typical copayment $29.40 (range $5.41 – $41.11)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MWATA O DYSON M.D.

Anesthesiology

100 NICOLLS RD, HSC L4 RM 060
STONY BROOK, NY 11794

Suffolk County (631) 444-2975

DR. MARTIN A GRUBER M.D.

Orthopaedic Surgery (Pediatric Orthopaedic Surgery)

100 NICOLLS RD
STONY BROOK, NY 11794

Suffolk County (516) 432-1872

MRS. KIMBERLY SUE TAFURI D.O

Pediatrics (Pediatric Endocrinology)

100 NICOLLS RD, STONY BROOK HOSPITAL DEPT OF PEDIATRICS HSC T11 ROOM080
STONY BROOK, NY 11794

Suffolk County (631) 444-3429

DR. KEITH THOMAS DIAZ M.D.

Internal Medicine

100 NICOLLS RD
STONY BROOK, NY 11794

Suffolk County (631) 444-2754

DR. ZUNAIRA SHARIEF PHARMD

Pharmacist

100 NICOLLS RD
STONY BROOK, NY 11794

Suffolk County (631) 444-7744

DR. HAROLD ALBERTO FERNANDEZ M.D.

Thoracic Surgery (Cardiothoracic Vascular Surgery)

100 NICOLLS RD, HSC L19-080
STONY BROOK, NY 11794

Suffolk County (631) 444-1820

DR. JAMES ROY TAYLOR JR. M.D.

Thoracic Surgery (Cardiothoracic Vascular Surgery)

100 NICOLLS RD, HSC L19-080
STONY BROOK, NY 11794

Suffolk County (631) 444-1820

NESTOR D BLYZNAK MD

Orthopaedic Surgery

100 NICOLLS RD
STONY BROOK, NY 11794

Suffolk County (631) 444-6996

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Nicole Forman's NPI number?

The NPI number for Nicole Forman is 1184570533. It was assigned to this individual provider in the NPPES registry on March 9, 2026.

Where is Nicole Forman located?

Nicole Forman practices at 100 Nicolls Rd Hsc 16-047, Stony Brook, NY 11794. The listed phone number is (631) 444-3457.

What is Nicole Forman's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Nicole Forman enrolled in Medicare?

Yes. Nicole Forman is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Nicole Forman was last updated on March 9, 2026. NPI Profile syncs with the weekly NPPES data releases published by CMS.