Provider Demographics
NPI:1346772969
Name:SNYDER, NICHOLAS EDWARD
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:EDWARD
Last Name:SNYDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 PLEASANTVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CENTRAL BRIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:12035-2415
Mailing Address - Country:US
Mailing Address - Phone:518-231-4907
Mailing Address - Fax:
Practice Address - Street 1:128 PLEASANTVIEW RD
Practice Address - Street 2:
Practice Address - City:CENTRAL BRIDGE
Practice Address - State:NY
Practice Address - Zip Code:12035-2415
Practice Address - Country:US
Practice Address - Phone:518-231-4907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-02
Last Update Date:2017-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY444731146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic