Basic Information
| Provider Information | |||||||||
| NPI: | 1265609820 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BELASCO | ||||||||
| FirstName: | NICHOLAS | ||||||||
| MiddleName: | D. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 GRAND STREET | ||||||||
| Address2: | 3RD FL | ||||||||
| City: | WARWICK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109901035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452910966 | ||||||||
| FaxNumber: | 8459875979 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 HATFIELD LN STE 1B | ||||||||
| Address2: | |||||||||
| City: | GOSHEN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109246753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452910966 | ||||||||
| FaxNumber: | 8452910983 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2008 | ||||||||
| LastUpdateDate: | 07/09/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS015228 | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 257849 | NY | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 25MB08512300 | NJ | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QS0010X | OS015228 | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 207QS0010X | 25MB08512300 | NJ | N | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 207QS0010X | 257849 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
No ID Information.