Provider Demographics
NPI:1982779666
Name:NIKOWITZ, SOUHA (PH D)
Entity Type:Individual
Prefix:
First Name:SOUHA
Middle Name:
Last Name:NIKOWITZ
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 BLANK LN
Mailing Address - Street 2:
Mailing Address - City:WATER MILL
Mailing Address - State:NY
Mailing Address - Zip Code:11976-2134
Mailing Address - Country:US
Mailing Address - Phone:917-403-6191
Mailing Address - Fax:
Practice Address - Street 1:347 5TH AVE
Practice Address - Street 2:SUITE 1500
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5010
Practice Address - Country:US
Practice Address - Phone:917-403-6191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014922103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVM4041Medicare ID - Type Unspecified