Basic Information
| Provider Information | |||||||||
| NPI: | 1083989859 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NICOLAOU | ||||||||
| FirstName: | NICOS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 CLOCK TOWER CMNS | ||||||||
| Address2: | |||||||||
| City: | BREWSTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105094055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8455924915 | ||||||||
| FaxNumber: | 8454628286 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 WESTAGE BUSINESS CTR DR STE 209 | ||||||||
| Address2: | |||||||||
| City: | FISHKILL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8458960736 | ||||||||
| FaxNumber: | 8458965196 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2012 | ||||||||
| LastUpdateDate: | 04/30/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | 261608 | NY | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.