Basic Information
Provider Information
NPI: 1871759845
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FIORE
FirstName: NICHOLAS
MiddleName: R.
NamePrefix: MR.
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 525 E 68TH ST
Address2:  
City: NEW YORK
State: NY
PostalCode: 100654870
CountryCode: US
TelephoneNumber: 2127462846
FaxNumber: 2127468108
Practice Location
Address1: 525 E 68TH ST
Address2:  
City: NEW YORK
State: NY
PostalCode: 100654870
CountryCode: US
TelephoneNumber: 2127462846
FaxNumber: 2127468108
Other Information
ProviderEnumerationDate: 07/30/2008
LastUpdateDate: 07/30/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X527591NYY Nursing Service ProvidersRegistered Nurse 

No ID Information.


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