# NICO PA PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497930531
- **Authorized official:** NICK N NICOLOFF (SOLE PROPRIETER)
- **Authorized official phone:** (917) 388-7644

## Contact information

- **Practice address:** 14 KIRKWOOD RD, 2ND FLOOR, PORT WASHINGTON, NY 11050-1437
- **Practice address phone:** (917) 388-7644
- **Mailing address:** 127 S BROADWAY, YONKERS, NY 10701-4006
- **Mailing address phone:** (917) 388-7644

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363AS0400X | Surgical Physician Assistant | 009001 | NY | Yes |

## Other

- **Enumeration date:** 01/08/2008
- **Last updated:** 01/08/2008