Provider Demographics
NPI:1093880957
Name:NICOLEAU, ARYEL (MD)
Entity Type:Individual
Prefix:
First Name:ARYEL
Middle Name:
Last Name:NICOLEAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9204 SPRINGFIELD BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11428
Mailing Address - Country:US
Mailing Address - Phone:718-465-3040
Mailing Address - Fax:718-464-9063
Practice Address - Street 1:9204 SPRINGFIELD BOULEVARD
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11428
Practice Address - Country:US
Practice Address - Phone:718-465-3040
Practice Address - Fax:718-464-9063
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY141741207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00587146Medicaid
B88558Medicare UPIN