Healthcare Provider Details

I. General information

NPI: 1316013287
Provider Name (Legal Business Name): NED NICOLAI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NORTH ST SUITE 101
GENEVA NY
14456-1561
US

IV. Provider business mailing address

200 NORTH ST SUITE 101
GENEVA NY
14456-1561
US

V. Phone/Fax

Practice location:
  • Phone: 315-787-5100
  • Fax: 315-787-5108
Mailing address:
  • Phone: 315-787-5200
  • Fax: 315-787-5221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number154431
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: