Provider Demographics
NPI:1467704353
Name:STEPHEN J. NICHOLAS MD PC
Entity Type:Organization
Organization Name:STEPHEN J. NICHOLAS MD PC
Other - Org Name:SCARSDALE ORTHO IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
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 1:130 EAST 77 ST.
Mailing Address - Street 2:FL 5
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075
Mailing Address - Country:US
Mailing Address - Phone:212-737-3301
Mailing Address - Fax:212-734-0407
Practice Address - Street 1:2 OVERHILL ROAD.
Practice Address - Street 2:#310
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583
Practice Address - Country:US
Practice Address - Phone:212-737-3301
Practice Address - Fax:212-734-0407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)