Carl A Nicoleau, MD PHD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

180270 Issued in NY

Practice address

2008 Seagirt Blvd
Far Rockaway, NY 11691-2803

Phone

(718) 565-6880

Fax

(877) 796-4457

NPI assigned

May 28, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Doctor of Philosophy

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H3359

Interoperability endpoints

• Direct secure messaging: nicoleaumd@canmp-ny.direct.office.nextgen.com

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

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  Medicare reassignment NPD
• Jackson Heights Medical Care PC

  • Sleep Medicine (Internal Medicine) Physician
  • Far Rockaway, NY
  • NPI 1003250762
  Medicare reassignment NPD
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  Medicare reassignment
• North Island Medical PLLC

  • Primary Care Clinic/Center
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  • NPI 1124890298
  NPD (past)
• Regine Medical PLLC

  • Cardiovascular Disease Physician
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  • NPI 1497294193
  NPD (past)

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

{
    "created_epoch": "1148774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724630400000",
    "number": "1396792867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2008 SEAGIRT BLVD",
            "city": "FAR ROCKAWAY",
            "state": "NY",
            "postal_code": "116912803",
            "telephone_number": "718-565-6880",
            "fax_number": "877-796-4457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2008 SEAGIRT BLVD",
            "city": "FAR ROCKAWAY",
            "state": "NY",
            "postal_code": "116912803",
            "telephone_number": "718-565-6880",
            "fax_number": "877-796-4457"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3712 92nd St Fl 2",
            "address_purpose": "LOCATION",
            "city": "Jackson Heights",
            "state": "NY",
            "postal_code": "113727930",
            "country_code": "US",
            "telephone_number": "718-565-6880",
            "fax_number": "877-796-4457",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6315 Roosevelt Ave",
            "address_purpose": "LOCATION",
            "city": "Woodside",
            "state": "NY",
            "postal_code": "113773641",
            "country_code": "US",
            "telephone_number": "718-565-6880",
            "fax_number": "877-796-4457",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NICOLEAU",
        "first_name": "CARL",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-28",
        "last_updated": "2024-08-26",
        "certification_date": "2024-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RS0012X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": "NY",
            "license": "141096",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "180270",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "180270",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01454842",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pnina Nisanov
• Rachel Nisanov
• Zina Niyazova, MSCCCSLP
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• Internal Medicine Physician in Far Rockaway, NY
• Providers in Far Rockaway, 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 Aug 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.