Basic Information
| Provider Information | |||||||||
| NPI: | 1083705743 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SZUMSKI | ||||||||
| FirstName: | NICHOLAS | ||||||||
| MiddleName: | R. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 250 N ROBERTSON BLVD | ||||||||
| Address2: | SUITE 518 | ||||||||
| City: | BEVERLY HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902111788 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103856016 | ||||||||
| FaxNumber: | 3103856080 | ||||||||
| Practice Location | |||||||||
| Address1: | 250 N ROBERTSON BLVD | ||||||||
| Address2: | SUITE 518 | ||||||||
| City: | BEVERLY HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902111788 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103856016 | ||||||||
| FaxNumber: | 3103856080 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2006 | ||||||||
| LastUpdateDate: | 02/06/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | A86807 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 00A86807 | 05 | CA | MEDICAID |