Organization
NEWPORT MEDICAL, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KAREN MAY NICKELL M.D. (OWNER)
(315) 502-4085
Entity
Organization
Contact information
Practice address
221 E MAIN ST, PALMYRA, NY 14522-1127
(315) 502-4085
(315) 502-4086
Mailing address
221 E MAIN ST, PALMYRA, NY 14522-1127
(315) 502-4085
(315) 502-4086
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
212521
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01914272
—
NY
01
—
1142
BLUE CROSS/ BLUE SHIELD
—
01
—
MDE045
PREFERRED CARE
—
01
—
P010212521
BLUE CHOICE
NY
Enumeration date
09/09/2008
Last updated
10/31/2008
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