JOHN MALLORY NICHOLSON MD NPI 1992730444

NPI Information

NPI: 1992730444
Provider Name: JOHN MALLORY NICHOLSON, MD
Classification: Psychiatry & Neurology - 2084P0804X
Entity Type: Individual

Specialization: Child & Adolescent Psychiatry

Address:
3043 STATE ROUTE 4
HUDSON FALLS, NY
ZIP 12839
Phone: (518) 747-2284
Get Directions

John Mallory Nicholson, MD is a child and adolescent psychiatry psychiatry neurology in Hudson Falls, NY. The provider is 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. John Mallory Nicholson, MD NPI is 1992730444. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

3043 STATE ROUTE 4
HUDSON FALLS, NY
ZIP 12839-632
Phone: (518) 747-2284
Fax: (518) 747-2253

The enumeration date for this NPI number is 7/12/2006 and was last updated on 5/19/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2084P0800X	Psychiatry & Neurology	Psychiatry	00126924	NEW YORK	No
2	2084P0804X	Psychiatry & Neurology	Child & Adolescent Psychiatry	00126924	NEW YORK	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	04042601887	OTHER		FIDELIS
2	10020051	OTHER		CDPHP
3	00490944002	OTHER		EMPIRE BC/BS BLUE CARD
4	53088A	OTHER		MVP
5	00490944002	OTHER		EMPIRE BC/BS
6	00490944002	OTHER		MEDICARE SENIOR BLUE
7	000490944002	OTHER		BLUE SHIELD
8	C64843	MEDICARE UPIN
9	55053B	MEDICARE ID-TYPE UNSPECIFIED
10	00490944002	OTHER		HEALTHNOW INTEGRATED
11	11123756	OTHER		CAQH
12	8U1371	OTHER		BLUE CROSS
13	00126924	MEDICAID	NEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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