Active NPI
Susan Nicholson, M.D.
- Infectious Disease Physician
- New York, NY
National Provider Identifier
1629418587
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Infectious Disease Physician
- License
- 197494
- Practice address
- 1300 York Ave
LC-423
New York, NY 10065-4805 - Phone
- (609) 647-7088
- NPI assigned
- Jun 25, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Infectious Disease Physician | 207RI0200X | 197494 | NY | Primary |
Addresses
Primary practice location
1300 York Ave
LC-423
New York, NY 10065-4805
Mailing address
123 Sandy Ridge Rd
Stockton, NJ 08559-1513
Phone (609) 647-7088
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 197494 | NY | MD | Infectious Disease Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1372118400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1372118400000",
"number": "1629418587",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "123 SANDY RIDGE RD",
"city": "STOCKTON",
"state": "NJ",
"postal_code": "085591513",
"telephone_number": "609-647-7088"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1300 YORK AVE",
"address_2": "LC-423",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100654805",
"telephone_number": "609-647-7088"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLSON",
"first_name": "SUSAN",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-06-25",
"last_updated": "2013-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "207RI0200X",
"taxonomy_group": "",
"desc": "Internal Medicine, Infectious Disease",
"state": "NY",
"license": "197494",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.