Provider Demographics
NPI:1083269047
Name:STEPHEN J NICHOLAS MD PC
Entity type:Organization
Organization Name:STEPHEN J NICHOLAS MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:NICHOLAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-737-3301
Mailing Address - Street 1:159 E 74TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3309
Mailing Address - Country:US
Mailing Address - Phone:212-737-3301
Mailing Address - Fax:
Practice Address - Street 1:2 OVERHILL RD STE 310
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-5316
Practice Address - Country:US
Practice Address - Phone:914-725-6970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEPHEN J NICHOLAS MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-07
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies