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General NPI Number Information
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NPI Number | 1598121139
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Entity Type | Individual
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Provider Name | NICHOLAS ELGAR CASAC - ADVANCED
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Gender | Male
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Dates
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Enumeration Date | 01/12/2016
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Last Update Date | 01/22/2021
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Provider Practice Location Address
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Address Line | 3425 VERNON BLVD
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City | LONG ISLAND CITY
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State | NY
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Zip | 11106-5121
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Country | US
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Telephone | 212-831-1555
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Fax |
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Provider Business Mailing Address
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Address Line | 45 ONECK LN
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City | WESTHAMPTON BEACH
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State | NY
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Zip | 11978-1907
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Country | US
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Telephone | 917-584-1802
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Fax |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 31798
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License Number State | NY
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