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General NPI Number Information
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NPI Number | 1396811287
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Entity Type | Individual
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Provider Name | ANDRZEJ NIKONOROW MD
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Gender | Male
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Dates
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Enumeration Date | 11/24/2006
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Last Update Date | 06/22/2009
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Provider Practice Location Address
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Address Line | 275 W 96 ST 32-F
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City | NEW YORK
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State | NY
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Zip | 10025-6271
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Country | US
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Telephone | 917-992-8294
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Fax | 212-644-9803
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Provider Business Mailing Address
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Address Line | 275 W 96 ST 32-F
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City | NEW YORK
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State | NY
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Zip | 10025-6271
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Country | US
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Telephone | 917-992-8294
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Fax | 212-644-9803
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 107312
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License Number State | NY
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