Provider Demographics
NPI:1457028003
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 1:159 E 74TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3309
Mailing Address - Country:US
Mailing Address - Phone:212-737-3301
Mailing Address - Fax:
Practice Address - Street 1:200 W 13TH ST FL 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7702
Practice Address - Country:US
Practice Address - Phone:212-737-3301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEPHEN J NICHOLAS MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies