Organization
JACKSON HEIGHTS MEDICAL CARE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARL A. NICHOLEAU (OWNER)
(718) 344-5293
Entity
Organization
Contact information
Practice address
2008 SEAGIRT BLVD, FAR ROCKAWAY, NY 11691-2803
(718) 565-6880
(877) 796-4457
Mailing address
7535 31ST AVE, SUITE 200, EAST ELMHURST, NY 11370-1857
(718) 565-6880
(718) 565-3102
Taxonomy
Speciality
Code
Description
License number
State
207RS0012X
Sleep Medicine (Internal Medicine) Physician
Primary
—
—
225100000X
Physical Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06748732
—
NY
01
—
G100516770
MEDICARE PROVIDER ID
NY
Enumeration date
04/24/2013
Last updated
08/26/2024
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