Provider Demographics
NPI:1114140266
Name:NICHOLS, NEIL SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:SCOTT
Last Name:NICHOLS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:125 KENNEDY DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-4017
Mailing Address - Country:US
Mailing Address - Phone:855-295-4144
Mailing Address - Fax:631-257-5098
Practice Address - Street 1:601 SUFFOLK AVE
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-4309
Practice Address - Country:US
Practice Address - Phone:855-295-4144
Practice Address - Fax:631-257-5098
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2021-01-29
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Provider Licenses
StateLicense IDTaxonomies
NY244448207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03038497Medicaid