Healthcare Provider Details

I. General information

NPI: 1598467185
Provider Name (Legal Business Name): NICHOLAS JAMES METHENY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 10/02/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 473 BOX 47 FPO AP
YOKOSUKA KANAGAWA
96349
JP

IV. Provider business mailing address

YOKOSUKA, HONCHO 2-1-19 RM#601 BLDG#2
YOKOSUKA KANAGAWA
2380041
JP

V. Phone/Fax

Practice location:
  • Phone: 315-241-8016
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number21353
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: