Samantha Josephine Nicholas | Middletown, NY • PECOS Search

Samantha Josephine Nicholas

Specialist

Other Service Providers

75 Crystal Run Rd Ste 201, Middletown, NY 10941-7010

(845) 692-4391 (845) 591-8745

PECOS Enrollment

Based on the most recent information from CMS, provider Samantha Josephine Nicholas does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 5 days ago.

Profile Details

Provider ID
1558922997
Provider Type
Individual
Full Name
Nicholas, Samantha Josephine
Gender
Female

Sole Proprietor
No
Enumeration Date
6/26/2019
Last Updated
6/26/2019

Contact Information

Practice Location

75 Crystal Run Rd Ste 201, Middletown, NY 10941-7010

Unlisted Fax

Mailing Location

1721 Lakes Rd, Monroe, NY 10950-4332

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 174400000X Primary	Description Specialist Other Service Providers	License Unlisted Issuer