Provider Demographics
NPI:1205158177
Name:JOHN J NICOSIA INC
Entity type:Organization
Organization Name:JOHN J NICOSIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:NICOSIA
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:310-325-6940
Mailing Address - Street 1:22930 CRENSHAW BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3048
Mailing Address - Country:US
Mailing Address - Phone:310-325-6940
Mailing Address - Fax:310-325-6973
Practice Address - Street 1:22930 CRENSHAW BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3048
Practice Address - Country:US
Practice Address - Phone:310-325-6940
Practice Address - Fax:310-325-6973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-19
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT2431225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT2431Medicare PIN