Healthcare Provider Details

I. General information

NPI: 1457028003
Provider Name (Legal Business Name): STEPHEN J NICHOLAS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

200 W 13TH ST FL 6
NEW YORK NY
10011-7702
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:
Mailing address:
  • Phone: 212-737-3301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

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