Provider Demographics
NPI:1265609820
Name:BELASCO, NICHOLAS D (DO)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:D
Last Name:BELASCO
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:20 GRAND STREET
Mailing Address - Street 2:3RD FL
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-1035
Mailing Address - Country:US
Mailing Address - Phone:845-291-0966
Mailing Address - Fax:845-987-5979
Practice Address - Street 1:1 HATFIELD LN STE 1B
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-6753
Practice Address - Country:US
Practice Address - Phone:845-291-0966
Practice Address - Fax:845-291-0983
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2020-07-09
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Provider Licenses
StateLicense IDTaxonomies
PAOS015228207Q00000X, 207QS0010X
NY257849207Q00000X, 207QS0010X
NJ25MB08512300207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine