Provider Demographics
NPI:1245301563
Name:STEADMAN, NICHOLAS COOKE (LAC)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:COOKE
Last Name:STEADMAN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 MAIN ST
Mailing Address - Street 2:#10P
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10044-0079
Mailing Address - Country:US
Mailing Address - Phone:646-509-8963
Mailing Address - Fax:
Practice Address - Street 1:133 E 58TH ST
Practice Address - Street 2:SUITE 307
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1236
Practice Address - Country:US
Practice Address - Phone:646-509-8963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003012171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist