Healthcare Provider Details

I. General information

NPI: 1023108115
Provider Name (Legal Business Name): JOHN C NICHOLS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 09/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WESTAGE BUSINESS CTR DR SUITE 110
FISHKILL NY
12524-2264
US

IV. Provider business mailing address

200 WESTAGE BUSINESS CTR DR SUITE 110
FISHKILL NY
12524-2264
US

V. Phone/Fax

Practice location:
  • Phone: 845-896-9280
  • Fax: 845-896-0246
Mailing address:
  • Phone: 845-896-9280
  • Fax: 845-896-0246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number256200
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: