Provider Demographics
NPI:1699851899
Name:MEGDANIS, NICHOLAS (DPM)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:MEGDANIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 610406
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-0406
Mailing Address - Country:US
Mailing Address - Phone:718-229-0222
Mailing Address - Fax:718-717-0275
Practice Address - Street 1:4401 FRANCIS LEWIS BLVD
Practice Address - Street 2:SUITE L3B
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3002
Practice Address - Country:US
Practice Address - Phone:718-229-0222
Practice Address - Fax:718-717-0275
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004326213EP1101X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY010499558Medicaid
NY6194960001Medicare NSC
NY03158GMedicare PIN
NYT32074Medicare UPIN