Provider Demographics
NPI:1003027459
Name:NICOL, MARTIN HAYNES SR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:HAYNES
Last Name:NICOL
Suffix:SR
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:145 REMSEN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-1342
Mailing Address - Country:US
Mailing Address - Phone:718-467-4280
Mailing Address - Fax:
Practice Address - Street 1:2367-69 2ND AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-3108
Practice Address - Country:US
Practice Address - Phone:212-876-2300
Practice Address - Fax:212-369-8209
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2012-07-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY003345-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant