Healthcare Provider Details

I. General information

NPI: 1285835637
Provider Name (Legal Business Name): NICK G. VATAKIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E 69TH ST SUITE 2H
NEW YORK NY
10021-5704
US

IV. Provider business mailing address

150 E 69TH ST SUITE 2H
NEW YORK NY
10021-5704
US

V. Phone/Fax

Practice location:
  • Phone: 212-249-6829
  • Fax: 212-249-8546
Mailing address:
  • Phone: 212-249-6829
  • Fax: 212-249-8546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number191863
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: