Provider Demographics
NPI:1053561936
Name:VAN MIEGHEM, NICOLAS M (MD)
Entity type:Individual
Prefix:DR
First Name:NICOLAS
Middle Name:M
Last Name:VAN MIEGHEM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:536 E 79TH ST
Mailing Address - Street 2:2 G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-1503
Mailing Address - Country:US
Mailing Address - Phone:646-546-8607
Mailing Address - Fax:
Practice Address - Street 1:130 EAST 77TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-434-6839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access