Healthcare Provider Details

I. General information

NPI: 1598790131
Provider Name (Legal Business Name): AURELIAN NICOLAE NICULESCU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/05/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 VETERANS AVE BH/116/76/511
BATH NY
14810-0810
US

IV. Provider business mailing address

31 HILLTOP DR
PITTSFORD NY
14534-2245
US

V. Phone/Fax

Practice location:
  • Phone: 607-664-4300
  • Fax:
Mailing address:
  • Phone: 585-255-0114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number255845
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number45395-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: