Organization Name: | NICKELS ALLERGY & ASTHMA, PC |
NPI Number: | 1295795300 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MICHAEL S NICKELS (PRESIDENT & CEO) |
Mailing Address: | 717 Market St Suite 105 Lemoyne |
State: | PA US |
Postal Code: | 170431581 |
Phone Number: | 7177373472 |
Fax Number: | 7177379707 |
NPI Enumeration Date: | 03/23/2006 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 207KA0200X |
License Number: | MD424414 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Allergy & Immunology |
Taxonomy Specialization: | Allergy |
Taxonomy Definition: |