Provider Demographics
NPI:1972849578
Name:NICHOLAS, EVANGELIA K (MD)
Entity Type:Individual
Prefix:
First Name:EVANGELIA
Middle Name:K
Last Name:NICHOLAS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:2 CATHARINE ST PARK SLOPE ANESTHESIA ASSOC, PC
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12602
Mailing Address - Country:US
Mailing Address - Phone:845-790-2614
Mailing Address - Fax:845-790-2313
Practice Address - Street 1:506 6TH ST
Practice Address - Street 2:NY METHODIST HOSPITAL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215
Practice Address - Country:US
Practice Address - Phone:718-780-3279
Practice Address - Fax:845-790-2613
Is Sole Proprietor?:No
Enumeration Date:2012-12-31
Last Update Date:2015-03-25
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA08256700207L00000X
NY216488-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY216488OtherNY LICENSE
NJ25MA08256700OtherLICENSE