Individual provider Active NPI

John Perry Nicholson, MD

  • Cardiovascular Disease Physician
  • Fresh Meadows, NY
National Provider Identifier
1326079153
Registry record updated Dec 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
138577 Issued in NY
Practice address
17403 Horace Harding Expy
Fresh Meadows, NY 11365-1527
Phone
(718) 670-1695
Fax
(516) 437-4167
NPI assigned
Jul 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 138577 NY Primary

Addresses

Primary practice location

17403 Horace Harding Expy
Fresh Meadows, NY 11365-1527

Mailing address

PO Box 27842
New York, NY 10087-7842
Phone (718) 670-1651

Other identifiers 1

IdentifierTypeStateIssuer
00856780MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100609000211 NY Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 2062542608 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
138577NYMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
New York Queens Medicine and Surgery, P.C. CurrentSince Jul 21, 2018 Accepting new patients
Newyork-Presbyterian/Queens Cardiovascular Disease CurrentSince Oct 1, 1993 Accepting new patients
Newyork-Presbyterian-Queens CurrentSince Oct 1, 1993 Accepting new patients
New York Queens Medicine and Surgery, P.C. CurrentSince Jul 21, 2018 Accepting new patients

Locations

17403 Horace Harding Expy
Fresh Meadows, NY 11365
Phone (718) 670-1365

16303 Horace Harding Expy
Fl 2
Fresh Meadows, NY 11365
Phone (718) 888-9121

17561 Hillside Ave
Ste 402
Jamaica, NY 11432
Phone (718) 670-1021

530 1st Ave
Ste 8U
New York, NY 10016
Phone (212) 263-7182

420 E 76th St
New York, NY 10021
Phone (212) 434-5300

1981 Marcus Ave
Ste 208
North New Hyde Park, NY 11042
Phone (718) 670-1415

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1292371200000",
    "number": "1326079153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27842",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100877842",
            "telephone_number": "718-670-1651",
            "fax_number": "516-437-4167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17403 HORACE HARDING EXPY",
            "city": "FRESH MEADOWS",
            "state": "NY",
            "postal_code": "113651527",
            "telephone_number": "718-670-1695",
            "fax_number": "516-437-4167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLSON",
        "first_name": "JOHN",
        "middle_name": "PERRY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-06",
        "last_updated": "2010-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NY",
            "license": "138577",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00856780",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresh Meadows, NY

Sources for this page

Verify at the official NPI Registry.