Basic Information
| Provider Information | |||||||||
| NPI: | 1972632420 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NIKA MEDICAL, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 MIDLAND AVE | ||||||||
| Address2: | |||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103062427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186677778 | ||||||||
| FaxNumber: | 7183177014 | ||||||||
| Practice Location | |||||||||
| Address1: | 55 MIDLAND AVE | ||||||||
| Address2: | |||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103062427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186677778 | ||||||||
| FaxNumber: | 7183177014 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2007 | ||||||||
| LastUpdateDate: | 04/16/2008 | ||||||||
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| AuthorizedOfficialLastName: | ROMASHOVA | ||||||||
| AuthorizedOfficialFirstName: | VERONIKA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 19178365296 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | 240566 | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.