Healthcare Provider Details

I. General information

NPI: 1477316636
Provider Name (Legal Business Name): NICHOLAS TERTINEK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2024
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 E 53RD ST
NEW YORK NY
10022-5243
US

IV. Provider business mailing address

301 W 45TH ST APT 2D
NEW YORK NY
10036-3823
US

V. Phone/Fax

Practice location:
  • Phone: 716-244-0906
  • Fax:
Mailing address:
  • Phone: 716-244-0906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number311530
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number311530
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number311530
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: