1467704353 NPI number — STEPHEN J. NICHOLAS MD PC

Table of content: (NPI 1467704353)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467704353 NPI number — STEPHEN J. NICHOLAS MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEPHEN J. NICHOLAS MD PC
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:
6
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:
1467704353
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 EAST 77 ST.
Provider Second Line Business Mailing Address:
FL 5
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10075
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-737-3301
Provider Business Mailing Address Fax Number:
212-734-0407

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 OVERHILL ROAD.
Provider Second Line Business Practice Location Address:
#310
Provider Business Practice Location Address City Name:
SCARSDALE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10583
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-737-3301
Provider Business Practice Location Address Fax Number:
212-734-0407
Provider Enumeration Date:
10/03/2012

Additional Information

Authorized Official

Authorized Official Last Name:
NICHOLAS
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
212-737-3301

Provider Taxonomy Codes

  • Taxonomy code: 261QM1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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