Provider Demographics
NPI:1295795300
Name:NICKELS ALLERGY & ASTHMA, PC
Entity type:Organization
Organization Name:NICKELS ALLERGY & ASTHMA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:NICKELS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:717-737-3472
Mailing Address - Street 1:PO BOX 341
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-0341
Mailing Address - Country:US
Mailing Address - Phone:717-737-3472
Mailing Address - Fax:717-737-9707
Practice Address - Street 1:717 MARKET ST
Practice Address - Street 2:SUITE 105
Practice Address - City:LEMOYNE
Practice Address - State:PA
Practice Address - Zip Code:17043-1581
Practice Address - Country:US
Practice Address - Phone:717-737-3472
Practice Address - Fax:717-737-9707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD424414207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAI 29882Medicare UPIN
PA091043Medicare ID - Type UnspecifiedPROVIDER NUMBER
PAT85Medicare PIN
PA091045T85Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER