Provider Demographics
NPI:1700593043
Name:NICOLE M. TYER, M.D., INC.
Entity Type:Organization
Organization Name:NICOLE M. TYER, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:TYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-544-1982
Mailing Address - Street 1:435 N ROXBURY DR STE 300
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5005
Mailing Address - Country:US
Mailing Address - Phone:310-278-1388
Mailing Address - Fax:
Practice Address - Street 1:435 N ROXBURY DR STE 300
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5005
Practice Address - Country:US
Practice Address - Phone:310-278-1388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care