Provider Demographics
NPI:1285835637
Name:VATAKIS, NICK G (MD)
Entity Type:Individual
Prefix:DR
First Name:NICK
Middle Name:G
Last Name:VATAKIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:150 E 69TH ST
Mailing Address - Street 2:SUITE 2H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5704
Mailing Address - Country:US
Mailing Address - Phone:212-249-6829
Mailing Address - Fax:212-249-8546
Practice Address - Street 1:150 E 69TH ST
Practice Address - Street 2:SUITE 2H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5704
Practice Address - Country:US
Practice Address - Phone:212-249-6829
Practice Address - Fax:212-249-8546
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY191863174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist