Provider Demographics
NPI:1801957253
Name:DEMOS, NICHOLAS JOHN (MD)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:JOHN
Last Name:DEMOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:142 PALISADE AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306
Mailing Address - Country:US
Mailing Address - Phone:201-420-1486
Mailing Address - Fax:201-420-1622
Practice Address - Street 1:142 PALISADE AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306
Practice Address - Country:US
Practice Address - Phone:201-420-1486
Practice Address - Fax:201-420-1622
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA01979500208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2721902Medicaid
C53880Medicare UPIN
NJ197754Medicare ID - Type Unspecified