MEDICARE: NICHOLAS EMERY

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	1223G0001X	General Practice Dentistry	054530	NY

General Provider Information

NPI Number	:	1972890002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS EMERY

Provider Business Mailing Address
First Line	:	2184 CHILI AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14624-3343
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2184 CHILI AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14624-3343
Country	:	US
Telephone Number	:	585-247-7110
Fax Number	:

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

Provider Enumeration Date	:	07/10/2011
Last Update Date	:	07/10/2011

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Directions to “ NICHOLAS EMERY ” Practice Location

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