Healthcare Provider Details

I. General information

NPI: 1831203645
Provider Name (Legal Business Name): NICHOLAS JOSEPH BATTAFARANO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 N 16TH ST
OMAHA NE
68102
US

IV. Provider business mailing address

3300 N 60TH ST
OMAHA NE
68104
US

V. Phone/Fax

Practice location:
  • Phone: 402-827-0570
  • Fax: 402-827-0580
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number23066
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberNE23066
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: