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General NPI Number Information
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NPI Number | 1609338292
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Entity Type | Individual
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Provider Name | NICOLAS GILLINGHAM MD
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Gender | Male
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Dates
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Enumeration Date | 04/02/2019
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 222 STATION PLZ N FL 5
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City | MINEOLA
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State | NY
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Zip | 11501-3800
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Country | US
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Telephone | 516-663-2521
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Fax | 516-663-9665
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Provider Business Mailing Address
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Address Line | 5645 MAIN ST
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City | FLUSHING
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State | NY
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Zip | 11355-5045
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Country | US
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Telephone |
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 321734
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License Number State | NY
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