Healthcare Provider Details

I. General information

NPI: 1306416334
Provider Name (Legal Business Name): NICHOLAS KWAN NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 1ST AVE
NEW YORK NY
10016-6402
US

IV. Provider business mailing address

1709 W 1ST ST FL 2
BROOKLYN NY
11223-1746
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-5800
  • Fax:
Mailing address:
  • Phone: 347-668-1480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License Number703452-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number703452
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: