Provider Demographics
NPI:1144784851
Name:STEPHEN J NICHOLAS MD PC
Entity Type:Organization
Organization Name:STEPHEN J NICHOLAS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:NICHOLAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-737-3301
Mailing Address - Street 1:PO BOX 16244
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4057
Mailing Address - Country:US
Mailing Address - Phone:212-737-3301
Mailing Address - Fax:
Practice Address - Street 1:1600 STEWART AVE
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-6696
Practice Address - Country:US
Practice Address - Phone:212-737-3301
Practice Address - Fax:212-734-0407
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEPHEN J NICHOLAS MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-27
Last Update Date:2019-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPENDINGOtherDMERC