Provider Demographics
NPI:1013016401
Name:NICAISE, ROBERT J (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:NICAISE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6294 SUNNYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-5333
Mailing Address - Country:US
Mailing Address - Phone:716-941-7838
Mailing Address - Fax:520-303-0568
Practice Address - Street 1:6294 SUNNYSIDE DR
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-5333
Practice Address - Country:US
Practice Address - Phone:716-941-7838
Practice Address - Fax:520-303-0568
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY155535207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine