Healthcare Provider Details

I. General information

NPI: 1093517393
Provider Name (Legal Business Name): STEPHEN J NICHOLAS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2025
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 OVERHILL RD STE 330
SCARSDALE NY
10583-5326
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: MD
Credential: MD
Phone: 212-737-3301