Individual
MS. KATY ANNE NICKOLAUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
160 E 53RD ST, NEW YORK, NY 10022-5243
(212) 639-2000
Mailing address
30 BUTTONWOOD DR, DIX HILLS, NY 11746-4805
(516) 376-4027
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
020308
NY
Other
Enumeration date
10/24/2016
Last updated
11/04/2016
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