Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 257849 | NY |
N | 207Q00000X | Family Doctor | 25MB08512300 | NJ |
N | 207Q00000X | Family Doctor | OS015228 | PA |
Y | 207QS0010X | Family Doctor - Sports Medicine | 257849 | NY |
N | 207QS0010X | Family Doctor - Sports Medicine | 25MB08512300 | NJ |
N | 207QS0010X | Family Doctor - Sports Medicine | OS015228 | PA |
NPI | 1265609820 |
---|---|
Provider Name | Dr. Nicholas D. Belasco |
First Address | Warwick, NY 10990-1035 |
Second Address | Goshen, NY 10924-6753 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2008 |
Last Update Date | 09/07/2020 |