Provider Demographics
NPI:1225090806
Name:SASSON, NICOLE (MD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:SASSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 STUYVESANT OVAL
Mailing Address - Street 2:5E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-2020
Mailing Address - Country:US
Mailing Address - Phone:212-472-6841
Mailing Address - Fax:212-995-8728
Practice Address - Street 1:6 EAST 45TH STREET
Practice Address - Street 2:#1205
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-2439
Practice Address - Country:US
Practice Address - Phone:212-995-8728
Practice Address - Fax:212-995-8728
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183962208100000X, 2081P0004X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P0004XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F33938Medicare UPIN