Provider Demographics
NPI:1760440093
Name:FIAVEY, NICHOLAS P (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:P
Last Name:FIAVEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 BLOOMING GROVE TPKE
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-7843
Mailing Address - Country:US
Mailing Address - Phone:845-562-8500
Mailing Address - Fax:845-561-8855
Practice Address - Street 1:537 BLOOMING GROVE TPKE
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-7843
Practice Address - Country:US
Practice Address - Phone:845-562-8500
Practice Address - Fax:845-561-8855
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201797207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0166196Medicaid
NY21N401Medicare ID - Type Unspecified
NY0166196Medicaid