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NPI Code Detail

MEDICARE: NICHOLAS KNICKERBOCKER

MEDICARE: NICHOLAS KNICKERBOCKER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselorC.2405762-TRNEOH

General Provider Information

NPI Number : 1013765957
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICHOLAS KNICKERBOCKER
Provider Business Mailing Address
First Line : 5445 SMITH RD
Second Line :
City : BROOKPARK
State : OH
Zip : 44142-2026
Country : US
Telephone Number : 216-598-2710
Fax Number :
Provider Business Practice Location Address
First Line : 3951 ROCKY RIVER DR
Second Line :
City : CLEVELAND
State : OH
Zip : 44111-4154
Country : US
Telephone Number : 216-598-2710
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/07/2024
Last Update Date : 05/07/2024

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Directions to “ NICHOLAS KNICKERBOCKER ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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