Healthcare Provider Details

I. General information

NPI: 1124462627
Provider Name (Legal Business Name): STEPHEN J NICHOLAS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2013
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 E 74TH ST
NEW YORK NY
10021-3235
US

IV. Provider business mailing address

159 E 74TH ST FL 2
NEW YORK NY
10021-3309
US

V. Phone/Fax

Practice location:
  • Phone: 212-737-3301
  • Fax: 212-734-0407
Mailing address:
  • Phone: 212-737-3301
  • Fax: 212-734-0407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number172648
License Number StateNY

VIII. Authorized Official

Name: STEPHEN J NICHOLAS
Title or Position: PRESIDENT
Credential: MD
Phone: 212-737-3301