1417001595 NPI number — THOMAS NICOLLA CONSULTING SERVICES, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417001595 NPI number — THOMAS NICOLLA CONSULTING SERVICES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS NICOLLA CONSULTING SERVICES, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417001595
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
711 TROY SCHENECTADY RD
Provider Second Line Business Mailing Address:
SUITE 209
Provider Business Mailing Address City Name:
LATHAM
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12110-2442
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-786-1667
Provider Business Mailing Address Fax Number:
518-786-1954

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
244 ONTARIO ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COHOES
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12047-2868
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-235-3358
Provider Business Practice Location Address Fax Number:
518-235-2823
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NICOLLA
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
518-786-1667

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000413955001 . This is a "BSNENY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: CH8550 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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