Provider Demographics
NPI:1922073410
Name:SOLOMOS, NICOLE A (DO)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:A
Last Name:SOLOMOS
Suffix:
Gender:F
Credentials:DO
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Other - Last Name:
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Mailing Address - Street 1:24 SAW MILL RIVER RD
Mailing Address - Street 2:SUTIE 206
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-1541
Mailing Address - Country:US
Mailing Address - Phone:914-631-7777
Mailing Address - Fax:914-631-0920
Practice Address - Street 1:24 SAW MILL RIVER RD
Practice Address - Street 2:SUTIE 206
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-1541
Practice Address - Country:US
Practice Address - Phone:914-631-7777
Practice Address - Fax:914-631-0920
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY228375207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014375920001Medicaid
NY02689196Medicaid
NY02689196Medicaid
I41837Medicare UPIN