Individual
FRED NICOLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
766 DANIEL ST, VALLEY STREAM, NY 11581-3502
(718) 240-5077
(718) 240-6621
Mailing address
766 DANIEL ST, VALLEY STREAM, NY 11581-3502
(631) 391-7887
(631) 454-4163
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
109349
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00193917
—
NY
Enumeration date
06/11/2006
Last updated
12/03/2019
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