=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548265747
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICHOLAS W TARRICONE M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2005
-----------------------------------------------------
Last Update Date | 01/23/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 179 RIVER ST
-----------------------------------------------------
City | ONEONTA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13820-2239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-433-3484
-----------------------------------------------------
Fax | 607-432-5790
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 346 GRAND AVE
-----------------------------------------------------
City | JOHNSON CITY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13790-2580
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-729-8156
-----------------------------------------------------
Fax | 607-729-3982
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 163534
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------