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General NPI Number Information
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NPI Number | 1700244324
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Entity Type | Individual
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Provider Name | NICHOLAS IMHOF
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Gender | Male
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Dates
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Enumeration Date | 02/10/2016
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Last Update Date | 02/10/2016
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Provider Practice Location Address
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Address Line | 1250 WATERS PL SUIT 1205
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City | BRONX
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State | NY
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Zip | 10461-2720
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Country | US
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Telephone | 347-810-7777
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Fax |
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Provider Business Mailing Address
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Address Line | 1250 WATERS PL SUIT 1205
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City | BRONX
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State | NY
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Zip | 10461-2720
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Country | US
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Telephone | 347-810-7777
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 002761
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License Number State | NY
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