Provider Demographics
NPI:1154408466
Name:NICHOLAS VARALLO MD PLLC
Entity type:Organization
Organization Name:NICHOLAS VARALLO MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:VARALLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-433-5454
Mailing Address - Street 1:670 DAVISON ROAD
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-5338
Mailing Address - Country:US
Mailing Address - Phone:716-433-5454
Mailing Address - Fax:716-478-0488
Practice Address - Street 1:670 DAVISON ROAD
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-5338
Practice Address - Country:US
Practice Address - Phone:716-433-5454
Practice Address - Fax:716-478-0488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY140206207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDC0107OtherRAILROAD MEDICARE
NYDC0107OtherRAILROAD MEDICARE
NY1154408466Medicare UPIN