Individual
JOHN MALLORY NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3043 STATE ROUTE 4, HUDSON FALLS, NY 12839-9632
(518) 747-2284
(518) 747-2253
Mailing address
3043 STATE ROUTE 4, HUDSON FALLS, NY 12839-9632
(518) 747-2284
(518) 747-2253
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
00126924
NY
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
00126924
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000490944002
BLUE SHIELD
—
05
—
00126924
—
NY
01
—
00490944002
HEALTHNOW INTEGRATED
—
01
—
04042601887
FIDELIS
—
01
—
10020051
CDPHP
—
01
—
11123756
CAQH
—
01
—
53088A
MVP
—
01
—
8U1371
BLUE CROSS
—
Enumeration date
07/12/2006
Last updated
05/19/2010
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