Provider Demographics
NPI:1669690954
Name:SEWELL, NICHOLAS LOUIS (MD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:LOUIS
Last Name:SEWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 E 79TH ST
Mailing Address - Street 2:APT. 13-C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-1034
Mailing Address - Country:US
Mailing Address - Phone:917-741-6269
Mailing Address - Fax:212-348-9594
Practice Address - Street 1:120 E 61ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-8102
Practice Address - Country:US
Practice Address - Phone:212-223-0716
Practice Address - Fax:212-223-0857
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152192174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist