Provider Demographics
NPI:1134622913
Name:KORONEOS, NICHOLAS (MS, DO)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:KORONEOS
Suffix:
Gender:M
Credentials:MS, DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 STETHEM DR
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-4083
Mailing Address - Country:US
Mailing Address - Phone:929-813-2742
Mailing Address - Fax:
Practice Address - Street 1:3980 HIGHWAY 9 E STE 300
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-8165
Practice Address - Country:US
Practice Address - Phone:843-646-8040
Practice Address - Fax:843-646-8049
Is Sole Proprietor?:No
Enumeration Date:2018-03-17
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC900562084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology