Provider Demographics
NPI:1427373216
Name:LA GAMMA, NICHOLAS ALEXANDER (MD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:ALEXANDER
Last Name:LA GAMMA
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 1:900 NORTHERN BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5337
Mailing Address - Country:US
Mailing Address - Phone:516-730-2100
Mailing Address - Fax:516-730-2121
Practice Address - Street 1:900 NORTHERN BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5337
Practice Address - Country:US
Practice Address - Phone:516-730-2100
Practice Address - Fax:516-730-2121
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-05
Last Update Date:2013-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60 265471208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery