Individual
DR. EDWARD ATKINSON NICHOLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
210 W 139TH ST, NEW YORK, NY 10030-2109
(212) 234-2121
(212) 234-1759
Mailing address
210 W 139TH ST, NEW YORK, NY 10030-2109
(212) 234-2121
(212) 234-1759
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
093296-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00151804
—
NY
01
—
676432
BLUE CROSS BLU SHIELD
NY
Enumeration date
11/22/2006
Last updated
04/27/2012
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