Healthcare Provider Details

I. General information

NPI: 1316933872
Provider Name (Legal Business Name): STEPHEN J NICHOLAS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 E 74TH ST FL 2
NEW YORK NY
10021-3309
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: 212-737-4876
Mailing address:
  • Phone: 212-737-3301
  • Fax: 212-737-4876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SHARON RAMNATH
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 212-737-3301