Healthcare Provider Details

I. General information

NPI: 1346571270
Provider Name (Legal Business Name): REFKY NICOLA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2010
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E ADAMS ST
SYRACUSE NY
13210-2306
US

IV. Provider business mailing address

750 E ADAMS ST DEPT OF
SYRACUSE NY
13210-1834
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-7439
  • Fax:
Mailing address:
  • Phone: 315-464-7439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number236652
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: