Healthcare Provider Details

I. General information

NPI: 1124502810
Provider Name (Legal Business Name): NICHOLAS PIKARSKY FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 CARTER PARK DR STE 3A
SENECA SC
29678-1152
US

IV. Provider business mailing address

5794 WIDEWATERS PKWY
SYRACUSE NY
13214-1845
US

V. Phone/Fax

Practice location:
  • Phone: 864-885-0058
  • Fax: 864-885-0098
Mailing address:
  • Phone: 315-422-1513
  • Fax: 315-422-5890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number343512
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number343512
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: