Healthcare Provider Details

I. General information

NPI: 1467704353
Provider Name (Legal Business Name): STEPHEN J. NICHOLAS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2012
Last Update Date: 10/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 OVERHILL ROAD. #310
SCARSDALE NY
10583
US

IV. Provider business mailing address

130 EAST 77 ST. FL 5
NEW YORK NY
10075
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 Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

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