Provider Demographics
NPI:1881067270
Name:NICOM THERAPEUTICS INC
Entity type:Organization
Organization Name:NICOM THERAPEUTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SZYMANSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:415-913-9332
Mailing Address - Street 1:1269 PEABODY LN
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-1113
Mailing Address - Country:US
Mailing Address - Phone:415-913-9332
Mailing Address - Fax:
Practice Address - Street 1:1269 PEABODY LN
Practice Address - Street 2:
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608-1113
Practice Address - Country:US
Practice Address - Phone:415-913-9332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health