Organization
ST. NICHOLAS PROFESSIONAL MEDICAL SERVICES OF NEW YORK LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FLORA KATSNELSON MD (OWNER/DIRECTOR)
(847) 257-1244
Entity
Organization
Contact information
Practice address
1264 SAINT NICHOLAS AVE STE A, NEW YORK, NY 10033-7263
(718) 301-1100
(224) 246-8042
Mailing address
304 WAINWRIGHT DR, NORTHBROOK, IL 60062-1900
(847) 257-1244
(224) 246-8042
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036113246
—
IL
Enumeration date
07/11/2017
Last updated
07/11/2017
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