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NPI Code Detail

MEDICARE: MARIA K NICKOLOVA M.D.

MEDICARE: MARIA K NICKOLOVA M.D.
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
12084P0800XPsychiatry Physician176758NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000510644006OTHERNYHEALTH INTEGRATED
21506150OTHERNYINDEPENDENT HEALTH
311123758OTHERNYCAQH
4145074OTHERNYVALUE OPTIONS
500010127103OTHERNYUNIVERA
6MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093718819
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIA K NICKOLOVA M.D.
Provider Business Mailing Address
First Line : 85 BRYANT WOODS S
Second Line :
City : AMHERST
State : NY
Zip : 14228-3604
Country : US
Telephone Number : 716-689-3333
Fax Number : 716-689-9866
Provider Business Practice Location Address
First Line : 85 BRYANT WOODS S
Second Line :
City : AMHERST
State : NY
Zip : 14228-3604
Country : US
Telephone Number : 716-689-3333
Fax Number : 716-689-9866
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2005
Last Update Date : 07/08/2007

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Directions to “ MARIA K NICKOLOVA M.D.” Practice Location

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