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NPI Code Detail

MEDICARE: DR. JAMES NICHOLSON M.D.

MEDICARE: DR. JAMES NICHOLSON M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207XS0114XAdult Reconstructive Orthopaedic Surgery Physician236798NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2660G31OTHERNYEMPIRE BC.BS
37333761OTHERNYAETNA

General Provider Information

NPI Number : 1043251655
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAMES NICHOLSON M.D.
Provider Business Mailing Address
First Line : PO BOX 1559
Second Line :
City : STONY BROOK
State : NY
Zip : 11790-0989
Country : US
Telephone Number : 631-444-4233
Fax Number :
Provider Business Practice Location Address
First Line : 14 TECHNOLOGY DR
Second Line :
City : EAST SETAUKET
State : NY
Zip : 11733-3472
Country : US
Telephone Number : 631-444-4233
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2006
Last Update Date : 07/08/2007

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