Provider Demographics
NPI:1336245109
Name:MAGLARAS, NICHOLAS C (MD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:C
Last Name:MAGLARAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 E WESTFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:ROSELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07204-2084
Mailing Address - Country:US
Mailing Address - Phone:908-245-8222
Mailing Address - Fax:908-245-6504
Practice Address - Street 1:236 E WESTFIELD AVE
Practice Address - Street 2:
Practice Address - City:ROSELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07204
Practice Address - Country:US
Practice Address - Phone:908-245-8222
Practice Address - Fax:908-245-6504
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA57937207RP1001X
NJ25MA05793700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6125107Medicaid
NJ6125107Medicaid
NJE50747Medicare UPIN