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General NPI Number Information
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NPI Number | 1295795300
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Entity Type | Organization
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Legal Business Name | NICKELS ALLERGY & ASTHMA, PC
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Dates
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Enumeration Date | 03/23/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 717 MARKET ST SUITE 105
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City | LEMOYNE
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State | PA
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Zip | 17043-1581
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Country | US
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Telephone | 717-737-3472
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Fax | 717-737-9707
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Provider Business Mailing Address
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Address Line | PO BOX 341
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City | HERSHEY
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State | PA
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Zip | 17033-0341
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Country | US
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Telephone | 717-737-3472
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Fax | 717-737-9707
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | MICHAEL S NICKELS
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Credential | M.D., PH.D
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Telephone | 717-737-3472
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number | MD424414
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License Number State | PA
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