1609591023 NPI number — STEPHEN J NICHOLAS MD PC

Table of content: (NPI 1609591023)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609591023 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:
1609591023
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 16244
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELFAST
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04915-4057
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:
162 E ROUTE 59 #1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NANUET
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10954
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:
Provider Enumeration Date:
10/07/2022

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XX0005X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: NA . This is a "DEMERC" identifier . This identifiers is of the category "OTHER".




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