MEDICARE: STEPHEN J NICHOLAS MD

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
1	207X00000X	Orthopaedic Surgery Physician	172648	NY
2	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	172648	NY

General Provider Information

NPI Number	:	1528053550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN J NICHOLAS MD

Provider Business Mailing Address
First Line	:	130 E 77TH ST
Second Line	:	5TH FLOOR
City	:	NYC
State	:	NY
Zip	:	10021-1851
Country	:	US
Telephone Number	:	212-737-3301
Fax Number	:	212-737-3301

Provider Business Practice Location Address
First Line	:	130 E 77TH ST
Second Line	:	5TH FLOOR
City	:	NYC
State	:	NY
Zip	:	10021-1851
Country	:	US
Telephone Number	:	212-737-3301
Fax Number	:	212-737-4876

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	09/11/2025

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