Provider Demographics
NPI:1760161285
Name:SAGALA, NICOLAS (RN)
Entity Type:Individual
Prefix:
First Name:NICOLAS
Middle Name:
Last Name:SAGALA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 10TH AVE APT 2B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-3037
Mailing Address - Country:US
Mailing Address - Phone:315-420-1286
Mailing Address - Fax:
Practice Address - Street 1:253 W 28TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-5914
Practice Address - Country:US
Practice Address - Phone:917-451-7018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY894496163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health