Provider Demographics
NPI:1548406226
Name:SASELU, NICHOLAS (RPH)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:SASELU
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 WATERFRONT PL
Mailing Address - Street 2:
Mailing Address - City:PORTCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10583
Mailing Address - Country:US
Mailing Address - Phone:914-937-7452
Mailing Address - Fax:914-937-7894
Practice Address - Street 1:25 WATERFRONT PL
Practice Address - Street 2:
Practice Address - City:PORT CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573-6001
Practice Address - Country:US
Practice Address - Phone:914-937-7452
Practice Address - Fax:914-937-7894
Is Sole Proprietor?:No
Enumeration Date:2008-12-30
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026739-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01300238Medicaid