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Individual

DR. LEROY NICKLES

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
170 W 12TH ST, EMERGENCY DEPT ADMINISTRATION, NEW YORK, NY 10011-8202
(212) 604-2590
Mailing address
870 SAINT NICHOLAS AVE APT D8, NEW YORK, NY 10032-5273
(212) 491-8725
(212) 491-8725

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
236503
NY
207P00000X
Emergency Medicine Physician
4301511279
MI
207P00000X
Emergency Medicine Physician
MD425081
PA

Other

Enumeration date
10/02/2006
Last updated
03/21/2024
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