Individual
DR. JONATHAN A NICKEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
185 SECOND AVE, GLOVERSVILLE, NY 12078-2510
(518) 773-2700
(518) 725-0527
Mailing address
185 SECOND AVE, GLOVERSVILLE, NY 12078-2510
(518) 773-2700
(518) 725-0527
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
221925
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02389980
—
NY
01
—
P00098601
MEDICARE RAILROAD
NY
Enumeration date
03/16/2006
Last updated
10/24/2007
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