Provider Demographics
NPI:1346279437
Name:VEROLA, NICHOLAS WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:WILLIAM
Last Name:VEROLA
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 1:2500 POND VW
Mailing Address - Street 2:SUITE 101
Mailing Address - City:S SCHODACK
Mailing Address - State:NY
Mailing Address - Zip Code:12033-9750
Mailing Address - Country:US
Mailing Address - Phone:518-477-2391
Mailing Address - Fax:518-477-2393
Practice Address - Street 1:3 ATRIUM DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1417
Practice Address - Country:US
Practice Address - Phone:518-438-5273
Practice Address - Fax:518-438-5398
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106913-1207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9469OtherBLUE SHIELD
NYCO 223384OtherWORKMANS COMP
NY34946OtherBLUE CROSS
NYY-141594827OtherCHAMPUS
NY00518483Medicaid
NY17104OtherMVP
NY10002103OtherCDPHP
NYAV7512937OtherDEA
NY33768BMedicare PIN
NYAV7512937OtherDEA
NYB802896Medicare UPIN