MEDICARE: DR. NICHOLAS THEODORE KARANIKOLAS 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
1	208800000X	Urology Physician	231957	NY

General Provider Information

NPI Number	:	1457417297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS THEODORE KARANIKOLAS M.D.

Provider Business Mailing Address
First Line	:	900 SOUTH AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3418
Country	:	US
Telephone Number	:	718-226-6461
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 SOUTH AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3418
Country	:	US
Telephone Number	:	718-226-6461
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	11/26/2019

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