Healthcare Provider Details

I. General information

NPI: 1366403057
Provider Name (Legal Business Name): JOSEPH ANTHONY NICHOLAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 07/05/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 SOUTH AVE BOX 58
ROCHESTER NY
14620-2733
US

IV. Provider business mailing address

1000 SOUTH AVE BOX 58
ROCHESTER NY
14620-2733
US

V. Phone/Fax

Practice location:
  • Phone: 585-341-6770
  • Fax: 585-341-8305
Mailing address:
  • Phone: 585-341-6770
  • Fax: 585-341-8305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number219959
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number219959
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number219959
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number219959
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: