Active NPI
Fred Nicolas, MD
- Surgery Physician
- Valley Stream, NY
National Provider Identifier
1982646410
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 109349
- Practice address
- 766 Daniel St
Valley Stream, NY 11581-3502 - Phone
- (718) 240-5077
- Fax
- (718) 240-6621
- NPI assigned
- Jun 11, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 109349 | NY | Primary |
Addresses
Primary practice location
766 Daniel St
Valley Stream, NY 11581-3502
Mailing address
766 Daniel St
Valley Stream, NY 11581-3502
Phone (631) 391-7887
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00193917 | Medicaid | NY |
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)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149984000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1575331200000",
"number": "1982646410",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "766 DANIEL ST",
"city": "VALLEY STREAM",
"state": "NY",
"postal_code": "115813502",
"telephone_number": "631-391-7887",
"fax_number": "631-454-4163"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "766 DANIEL ST",
"city": "VALLEY STREAM",
"state": "NY",
"postal_code": "115813502",
"telephone_number": "718-240-5077",
"fax_number": "718-240-6621"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICOLAS",
"first_name": "FRED",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-11",
"last_updated": "2019-12-03",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "NY",
"license": "109349",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00193917",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Valley Stream, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.