JOHN MALLORY NICHOLSON (NPI# 1992730444) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992730444 |
| Entity Type | Individual |
| Full Name | JOHN MALLORY NICHOLSON |
| Credential | MD |
| Practice Address |
3043 State Route 4 Hudson Falls NY 12839-9632 |
| Practice Telephone | 5187472284 |
| Practice Fax Number | 5187472253 |
| Mailing Telephone | 5187472284 |
| Mailing Fax Number | 5187472253 |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2010-05-19 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
00126924 | NY | Allopathic & Osteopathic Physicians |
| Y | 2084P0804X |
Psychiatry & Neurology Specialization: Child & Adolescent Psychiatry |
00126924 | NY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 00126924 | 05 | |
| MVP | 53088A | 01 | |
| BLUE SHIELD | 000490944002 | 01 | |
| EMPIRE BC/BS | 00490944002 | 01 | |
| EMPIRE BC/BS BLUE CARD | 00490944002 | 01 | |
| CDPHP | 10020051 | 01 | |
| BLUE CROSS | 8U1371 | 01 | |
| MEDICARE SENIOR BLUE | 00490944002 | 01 | |
| HEALTHNOW INTEGRATED | 00490944002 | 01 | |
| FIDELIS | 04042601887 | 01 | |
| CAQH | 11123756 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518243641 | John M Nicholson | Pharmacist | 260 W New Circle Rd, Lexington, KY 40505-1426 | 2011-11-03 |
| 1548550833 | John Richard Nicholson IIi | Internal Medicine | 201 Sivley Rd Sw Ste 200, Huntsville, AL 35801-5177 | 2011-04-08 |
| 1023176625 | John Louis Nicholson | Clinic/Center | 715 Altos Oaks Dr, Los Altos, CA 94024-5402 | 2006-12-05 |
| 1497723795 | John Nicholson | Internal Medicine | 728 Hartness Rd, Statesville, NC 28677-3425 | 2006-03-10 |
| 1316448459 | John Kirkwood Nicholson | Student in an Organized Health Care Education/Training Program | 8901 Wisconsin Ave, Bethesda, MD 20889-0004 | 2018-02-23 |
| 1568819449 | John Forrest Nicholson IIi | Nurse Anesthetist, Certified Registered | 129 N Washington St, Sumter, SC 29150-4949 | 2016-05-19 |
| 1790095933 | John David Nicholson Jr. | Physician Assistant | 111 N 49th St, Philadelphia, PA 19139-2718 | 2010-10-20 |
| 1184859100 | John E Nicholson | Dentist | 187 New Hackensack Rd, Wappingers Falls, NY 12590-1726 | 2009-05-19 |
| 1205021516 | John Henry Nicholson | Family Medicine | 169 Delaware Ave, Palmerton, PA 18071-1708 | 2007-09-10 |
| 1699872101 | John Dailey Nicholson | Surgery | 5100 W Taft Rd, Suite 4a, Liverpool, NY 13088 | 2006-09-19 |
| Street Address |
3043 STATE ROUTE 4 |
| City | HUDSON FALLS |
| State | NY |
| Zip Code | 12839-9632 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134199078 | Donald Walter Kowalski | Psychiatry & Neurology | 3043 State Route 4, Hudson Falls, NY 12839-9632 | 2006-01-24 |
| 1003448556 | Rebecca Ryan | Social Worker | 3043 State Route 4, Hudson Falls, NY 12839-9632 | 2020-02-12 |
| 1932742178 | Kayla R Elder | Social Worker | 3043 State Route 4, Hudson Falls, NY 12839-9632 | 2019-10-21 |
| 1821554577 | Savannah Hollae Davis | Social Worker | 3043 State Route 4, Hudson Falls, NY 12839-9632 | 2019-02-19 |
| 1295209674 | Christina Porter | Licensed Practical Nurse | 3043 State Route 4, Hudson Falls, NY 12839-9632 | 2019-01-18 |
| 1720552326 | Marjeta Kane | Social Worker | 3043 State Route 4, Hudson Falls, NY 12839-9632 | 2019-01-16 |
| 1477063675 | Danika E Robbins | Social Worker | 3043 State Route 4, Hudson Falls, NY 12839-9632 | 2017-10-03 |
| 1013426006 | Lindsay Madigan | Social Worker | 3043 State Route 4, Hudson Falls, NY 12839-9632 | 2017-09-22 |
| 1437694569 | Suzanne Marie Giordano | Counselor | 3043 State Route 4, Hudson Falls, NY 12839-9632 | 2016-12-28 |
| 1245789015 | Michelle Mann-saumier | Counselor | 3043 State Route 4, Hudson Falls, NY 12839-9632 | 2016-09-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417555814 | Marissa Whiting | Social Worker | 3043 Us 4, Hudson Falls, NY 12839 | 2020-10-16 |
| 1598381568 | Alli Jennifer Clark | Social Worker | 15 Boulevard, Hudson Falls, NY 12839 | 2020-06-24 |
| 1720614399 | Rebecca Lynn Leclaire | Registered Nurse | 1051 Dix Avenue, Hudson Falls, NY 12839 | 2020-03-16 |
| 1902444821 | Sydney Dwinell Ayotte | Social Worker | 3043 Us Route 4, Hudson Falls, NY 12839 | 2019-12-11 |
| 1013572809 | Dme Consulting Agency LLC | Durable Medical Equipment & Medical Supplies | 146 River Street, Hudson Falls, NY 12839 | 2019-05-07 |
| 1487165296 | Jessica Percetti | Registered Nurse | 80 E Labarge Street, Hudson Falls, NY 12839 | 2017-10-19 |
| 1811443575 | Misty Jane Lacross | Registered Nurse | 80 East Labarge Street, Hudson Falls, NY 12839 | 2016-08-31 |
| 1851709042 | Danielle Marie Tortorici | Physician Assistant | 340a Main Street, Hudson Falls, NY 12839 | 2014-07-31 |
| 1538464862 | Maria C Luciani | Social Worker | 15 Bouelvard Street, Hudson Falls, NY 12839 | 2011-01-18 |
| 1811218837 | Michelle L Burke | Registered Nurse | 80 E. Labarge St., Hudson Falls, NY 12839 | 2010-06-14 |
| Find all providers in zip 12839 | ||||
| Taxonomy Code | 2084P0804X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Child & Adolescent Psychiatry |
| Child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093327611 | Adel Mostafavi, Md PC | Psychiatry & Neurology | 104 W 40th St Rm 400, New York, NY 10018-3692 | 2020-08-17 |
| 1023632015 | Child and Adult Clinical Psychiatry PC | Psychiatry & Neurology | 75 Prospect St Ste 110, Huntington, NY 11743-3320 | 2020-06-04 |
| 1598306441 | Place of Mind Child, Adolescent, and Adult Psychiatry P.C. | Psychiatry & Neurology | 240 Central Park S Apt 2h, New York, NY 10019-1435 | 2019-10-02 |
| 1881102267 | Park Avenue Physicians PC | Psychiatry & Neurology | 5 W 86th St Apt 1b, New York, NY 10024-3663 | 2018-01-19 |
| 1518478080 | Diego G. Calabria Physician P.C. | Psychiatry & Neurology | 366 N Broadway Ste 304, Jericho, NY 11753-2000 | 2017-10-23 |
| 1013426865 | Bebsy Estefan Md PC | Psychiatry & Neurology | 3050 Corlear Ave # Phb, Bronx, NY 10463-5180 | 2017-09-25 |
| 1902281629 | Derek Rudge | Psychiatry & Neurology | 1051 Riverside Dr Rm 235, New York, NY 10032-1007 | 2015-07-23 |
| 1275918096 | Dr Omar Bashayan Physician Pllc | Psychiatry & Neurology | 155 W 68th St Apt 1102, New York, NY 10023-5816 | 2015-07-22 |
| 1740676766 | Maura E Tappen | Psychiatry & Neurology | 1860 South Ave, Rochester, NY 14620-4229 | 2015-04-07 |
| 1194119560 | Krishen Persaud | Psychiatry & Neurology | Stony Brook Psychiatric Associates, Ufpc, Sbumc, Hsc Level 10, Rm.020, Stony Brook, NY 11794-8101 | 2015-03-24 |
| Find all providers with the same taxonomy | ||||
| City | HUDSON FALLS |
| Zip Code | 12839 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.