Joseph Jean Nicolas, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

130265 Issued in NY

Practice address

10415 Springfield Blvd
Queens Village, NY 11429-2032

Phone

(718) 776-6050

Fax

(718) 776-6051

NPI assigned

Nov 2, 2006

Reactivated

Oct 5, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475625600000",
    "number": "1386723229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1952 MIDLANE S",
            "city": "SYOSSET",
            "state": "NY",
            "postal_code": "117919606",
            "telephone_number": "516-921-2794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10415 SPRINGFIELD BLVD",
            "city": "QUEENS VILLAGE",
            "state": "NY",
            "postal_code": "114292032",
            "telephone_number": "718-776-6050",
            "fax_number": "718-776-6051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICOLAS",
        "first_name": "JOSEPH",
        "middle_name": "JEAN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-02",
        "last_updated": "2016-10-05",
        "deactivation_date": "2016-09-27",
        "reactivation_date": "2016-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "130265",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00443210",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sandriana Ngwi
• Nicole Tamara Nicholas, M.A.
• Colleen Nicholls Zarinsky
• Saskia Nicholls
• Karen Maria Nicholson, OCCUPATIONAL THERAPY
• Aryel Nicoleau, MD
• Barbara Georgia Nictas, LCSW
• Tova Nissenbaum
• Magdaline Woyisungazi Nji, LPN
• Anthonia Nnadi

• Internal Medicine Physician in Queens Village, NY
• Providers in Queens Village, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.