Healthcare Provider Details

I. General information

NPI: 1538939368
Provider Name (Legal Business Name): JOHN K NIA MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2024
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 LAFAYETTE ST APT 3S
NEW YORK NY
10012-4084
US

IV. Provider business mailing address

242 LAFAYETTE ST APT 3S
NEW YORK NY
10012-4084
US

V. Phone/Fax

Practice location:
  • Phone: 516-650-0933
  • Fax:
Mailing address:
  • Phone: 516-650-0933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN NIA
Title or Position: OWNER
Credential: MD
Phone: 516-650-0933