Healthcare Provider Details

I. General information

NPI: 1073863015
Provider Name (Legal Business Name): OLIVIER F NICOLAY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 E 58TH ST SUITE 912
NEW YORK NY
10022-1236
US

IV. Provider business mailing address

133 E 58TH ST SUITE 912
NEW YORK NY
10022-1236
US

V. Phone/Fax

Practice location:
  • Phone: 212-207-8028
  • Fax: 212-207-8074
Mailing address:
  • Phone: 212-207-8028
  • Fax: 212-207-8074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number043317
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: