Provider Demographics
NPI:1396811287
Name:NIKONOROW, ANDRZEJ (MD)
Entity type:Individual
Prefix:
First Name:ANDRZEJ
Middle Name:
Last Name:NIKONOROW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:275 W 96 ST
Mailing Address - Street 2:32-F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6271
Mailing Address - Country:US
Mailing Address - Phone:917-992-8294
Mailing Address - Fax:212-644-9803
Practice Address - Street 1:275 W 96 ST
Practice Address - Street 2:32-F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6271
Practice Address - Country:US
Practice Address - Phone:917-992-8294
Practice Address - Fax:212-644-9803
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1073122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry