Healthcare Provider Details

I. General information

NPI: 1528053550
Provider Name (Legal Business Name): STEPHEN J NICHOLAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 E 77TH ST 5TH FLOOR
NYC NY
10021-1851
US

IV. Provider business mailing address

130 E 77TH ST 5TH FLOOR
NYC NY
10021-1851
US

V. Phone/Fax

Practice location:
  • Phone: 212-737-3301
  • Fax: 212-737-4876
Mailing address:
  • Phone: 212-737-3301
  • Fax: 212-737-3301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number172648
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number172648
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: