Provider Demographics
NPI:1740215953
Name:CAMPION, NICHOLAS J (DPM)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:J
Last Name:CAMPION
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17809 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-4624
Mailing Address - Country:US
Mailing Address - Phone:718-657-4445
Mailing Address - Fax:718-657-4447
Practice Address - Street 1:17809 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4624
Practice Address - Country:US
Practice Address - Phone:718-657-4445
Practice Address - Fax:718-657-4447
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005803-1213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02598887Medicaid
NY6514320001OtherDME PTAN
U91251Medicare UPIN
NY6514320001Medicare NSC
NY02598887Medicaid