MEDICARE: NICHOLAS GEORGE NASSER

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1720737000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS GEORGE NASSER

Provider Business Mailing Address
First Line	:	1 GUSTAVE L. PLACE
Second Line	:	BOX 1149
City	:	NEW YORK
State	:	NY
Zip	:	10029
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 GUSTAVE L LEVY PL
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029-6504
Country	:	US
Telephone Number	:	212-241-6500
Fax Number	:

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

Provider Enumeration Date	:	03/22/2022
Last Update Date	:	02/23/2026

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